Provider Demographics
NPI:1659147429
Name:DEEP RIVER COUNSELING LLC
Entity Type:Organization
Organization Name:DEEP RIVER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:651-243-0077
Mailing Address - Street 1:1611 COUNTY ROAD B W
Mailing Address - Street 2:STE 201
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4107
Mailing Address - Country:US
Mailing Address - Phone:651-243-0077
Mailing Address - Fax:651-273-2201
Practice Address - Street 1:1611 COUNTY ROAD B W
Practice Address - Street 2:STE 201
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4107
Practice Address - Country:US
Practice Address - Phone:651-243-0077
Practice Address - Fax:651-273-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty