Provider Demographics
NPI:1497053458
Name:UPTOWN COUNSELING P A
Entity Type:Organization
Organization Name:UPTOWN COUNSELING P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUESS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP, LMFT
Authorized Official - Phone:612-823-5101
Mailing Address - Street 1:3249 HENNEPIN AVE S
Mailing Address - Street 2:SUITE 144
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3411
Mailing Address - Country:US
Mailing Address - Phone:612-823-5101
Mailing Address - Fax:
Practice Address - Street 1:3249 HENNEPIN AVE S
Practice Address - Street 2:SUITE 144
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3411
Practice Address - Country:US
Practice Address - Phone:612-823-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2430251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health