Provider Demographics
NPI:1538463435
Name:BJERKE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BJERKE COUNSELING SERVICES, LLC
Other - Org Name:MARKET PLACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:320-253-4080
Mailing Address - Street 1:110 SECOND STREET, SOUTH
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387
Mailing Address - Country:US
Mailing Address - Phone:320-253-4080
Mailing Address - Fax:320-253-4088
Practice Address - Street 1:110 SECOND STREET, SOUTH
Practice Address - Street 2:SUITE 303
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387
Practice Address - Country:US
Practice Address - Phone:320-253-4080
Practice Address - Fax:320-253-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
171093128Medicare UPIN