Provider Demographics
NPI:1598186330
Name:BIRCH COUNSELING, PLLC.
Entity Type:Organization
Organization Name:BIRCH COUNSELING, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BACIGALUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-522-2472
Mailing Address - Street 1:32 10TH AVE S STE 212
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9481
Mailing Address - Country:US
Mailing Address - Phone:866-522-2472
Mailing Address - Fax:651-426-6439
Practice Address - Street 1:904 MAINSTREET STE 200
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7589
Practice Address - Country:US
Practice Address - Phone:866-244-2472
Practice Address - Fax:763-717-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC00186101YM0800X
103TC1900X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1598186330Medicaid