Provider Demographics
NPI:1497160782
Name:JUDY ROTACH COUNSELING, PLLC
Entity Type:Organization
Organization Name:JUDY ROTACH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTACH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:651-482-9361
Mailing Address - Street 1:900 LONG LAKE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6439
Mailing Address - Country:US
Mailing Address - Phone:651-482-9361
Mailing Address - Fax:651-482-9888
Practice Address - Street 1:900 LONG LAKE RD STE 320
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6439
Practice Address - Country:US
Practice Address - Phone:651-482-9361
Practice Address - Fax:651-482-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty