Provider Demographics
NPI:1558371955
Name:HIGHLAND PARK COUNSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:HIGHLAND PARK COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERVEN
Authorized Official - Middle Name:SEARS
Authorized Official - Last Name:BERVEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-690-0953
Mailing Address - Street 1:790 CLEVELAND AVE S STE 207
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3866
Mailing Address - Country:US
Mailing Address - Phone:651-690-0953
Mailing Address - Fax:651-690-0968
Practice Address - Street 1:790 CLEVELAND AVE S STE 207
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3866
Practice Address - Country:US
Practice Address - Phone:651-690-0953
Practice Address - Fax:651-690-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN576717200Medicaid