Provider Demographics
NPI:1629573449
Name:NORTHERN PINES COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:NORTHERN PINES COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HELSETH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, RPT
Authorized Official - Phone:763-234-0240
Mailing Address - Street 1:277 COON RAPIDS BLVD NW STE 402
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5865
Mailing Address - Country:US
Mailing Address - Phone:763-234-0240
Mailing Address - Fax:763-205-1149
Practice Address - Street 1:277 COON RAPIDS BLVD NW STE 402
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5865
Practice Address - Country:US
Practice Address - Phone:763-234-0240
Practice Address - Fax:763-205-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-25
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00271261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health