Provider Demographics
NPI:1679554497
Name:CEDAR RIVER COUNSELING & EDUCATIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:CEDAR RIVER COUNSELING & EDUCATIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,LP
Authorized Official - Phone:507-433-6482
Mailing Address - Street 1:1403 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1911
Mailing Address - Country:US
Mailing Address - Phone:507-433-6482
Mailing Address - Fax:507-433-0097
Practice Address - Street 1:1403 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1911
Practice Address - Country:US
Practice Address - Phone:507-433-6482
Practice Address - Fax:507-433-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3235103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1265413777Medicaid
MN1265413777Medicaid