Provider Demographics
NPI:1669849808
Name:JACQUI RUZICKA COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:JACQUI RUZICKA COUNSELING SERVICES, LLC
Other - Org Name:SERENITY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPCC
Authorized Official - Phone:320-282-2591
Mailing Address - Street 1:225 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1623
Mailing Address - Country:US
Mailing Address - Phone:320-455-9888
Mailing Address - Fax:
Practice Address - Street 1:255 HIGHWAY 7 E
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1749
Practice Address - Country:US
Practice Address - Phone:320-282-2591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health