Provider Demographics
NPI:1487864161
Name:EAST CENTRAL COUNSELING CENTER
Entity Type:Organization
Organization Name:EAST CENTRAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNAAS
Authorized Official - Suffix:
Authorized Official - Credentials:LIC SW
Authorized Official - Phone:651-674-8822
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0502
Mailing Address - Country:US
Mailing Address - Phone:651-674-8822
Mailing Address - Fax:651-277-8822
Practice Address - Street 1:38625 14TH AVE
Practice Address - Street 2:SUITE#D
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6682
Practice Address - Country:US
Practice Address - Phone:651-674-8822
Practice Address - Fax:651-277-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6G186EAOtherBCBS
MN=========OtherTAX ID