Provider Demographics
NPI:1578141875
Name:COUNTY LINE COUNSELING, LLC
Entity Type:Organization
Organization Name:COUNTY LINE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITHAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC
Authorized Official - Phone:507-526-2468
Mailing Address - Street 1:32093 115TH STREET
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013
Mailing Address - Country:US
Mailing Address - Phone:507-526-2468
Mailing Address - Fax:507-526-2480
Practice Address - Street 1:220 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-1966
Practice Address - Country:US
Practice Address - Phone:507-526-2468
Practice Address - Fax:507-526-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty