Provider Demographics
NPI:1669834099
Name:MERCY'S PLACE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MERCY'S PLACE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:507-226-7963
Mailing Address - Street 1:3228 6TH AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3808
Mailing Address - Country:US
Mailing Address - Phone:507-226-7963
Mailing Address - Fax:507-258-5000
Practice Address - Street 1:3228 6TH AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3808
Practice Address - Country:US
Practice Address - Phone:507-226-7963
Practice Address - Fax:507-258-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4160103TC0700X
MN124181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty