Provider Demographics
NPI:1568973535
Name:CLR COUNSELING
Entity Type:Organization
Organization Name:CLR COUNSELING
Other - Org Name:CATHERINE RUSSELL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LENORE
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-325-1905
Mailing Address - Street 1:1409 WILLOW ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3289
Mailing Address - Country:US
Mailing Address - Phone:612-325-1905
Mailing Address - Fax:888-314-7340
Practice Address - Street 1:1409 WILLOW ST STE 305
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3289
Practice Address - Country:US
Practice Address - Phone:612-325-1905
Practice Address - Fax:888-314-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1235550575Medicaid