Provider Demographics
NPI:1508081167
Name:PCC, INC
Entity Type:Organization
Organization Name:PCC, INC
Other - Org Name:PROFESSIONAL COUNSELING CENTER OF DELANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MIELKE
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:763-972-6527
Mailing Address - Street 1:620 BABCOCK BLVD E
Mailing Address - Street 2:PO BOX 558
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8603
Mailing Address - Country:US
Mailing Address - Phone:763-972-6527
Mailing Address - Fax:763-972-3965
Practice Address - Street 1:620 BABCOCK BLVD E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8603
Practice Address - Country:US
Practice Address - Phone:763-972-6527
Practice Address - Fax:763-972-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN804117-2-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health