Provider Demographics
NPI:1629159678
Name:QOL GUIDANCE PC
Entity Type:Organization
Organization Name:QOL GUIDANCE PC
Other - Org Name:LINDA K GORDON
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT SOLE EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LP LADC
Authorized Official - Phone:651-688-3168
Mailing Address - Street 1:4651 NICOLS RD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3336
Mailing Address - Country:US
Mailing Address - Phone:651-688-3168
Mailing Address - Fax:651-688-3583
Practice Address - Street 1:4651 NICOLS RD
Practice Address - Street 2:SUITE 102A
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3336
Practice Address - Country:US
Practice Address - Phone:651-688-3168
Practice Address - Fax:651-688-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3677103T00000X, 103TC1900X
MNLADC300273103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN499R3QOOtherBLUE CROSS BLUE SHIELD
MN6254046OtherUNITED BEHAVIORAL HEALTH
MN7496066OtherAETNA