Provider Demographics
NPI:1598099871
Name:CORE RESTORE COUNSELING, LLC
Entity Type:Organization
Organization Name:CORE RESTORE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSSING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-286-4257
Mailing Address - Street 1:12760 ABERDEEN ST NE STE 205
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5847
Mailing Address - Country:US
Mailing Address - Phone:763-286-4257
Mailing Address - Fax:763-432-7424
Practice Address - Street 1:12760 ABERDEEN ST NE STE 205
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5847
Practice Address - Country:US
Practice Address - Phone:763-286-4257
Practice Address - Fax:763-432-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1185251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health