Provider Demographics
NPI:1518378470
Name:KNUSTON COUNSELING AND SEMINARS, INC.
Entity Type:Organization
Organization Name:KNUSTON COUNSELING AND SEMINARS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELOUISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-235-1121
Mailing Address - Street 1:1604 1ST ST S
Mailing Address - Street 2:SUITE NUMBER #225
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4243
Mailing Address - Country:US
Mailing Address - Phone:320-235-1121
Mailing Address - Fax:320-235-0099
Practice Address - Street 1:1604 1ST ST SW
Practice Address - Street 2:SUITE NUMBER #225
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4243
Practice Address - Country:US
Practice Address - Phone:320-235-1121
Practice Address - Fax:320-235-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1151252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN011064700Medicaid
MNC05542800002451Medicare PIN