Provider Demographics
NPI:1730105479
Name:NORTH STAR COUNSELING A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type:Organization
Organization Name:NORTH STAR COUNSELING A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:NORTH STAR COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:559-297-6060
Mailing Address - Street 1:624 WOODWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1847
Mailing Address - Country:US
Mailing Address - Phone:559-297-6060
Mailing Address - Fax:559-297-6061
Practice Address - Street 1:624 WOODWORTH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1847
Practice Address - Country:US
Practice Address - Phone:559-297-6060
Practice Address - Fax:559-297-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS148761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02144ZMedicare PIN