Provider Demographics
NPI:1750496295
Name:EFFECTIVE LIVING CENTER, INC
Entity Type:Organization
Organization Name:EFFECTIVE LIVING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER-STEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LSW, LPC
Authorized Official - Phone:320-632-3166
Mailing Address - Street 1:103 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-2854
Mailing Address - Country:US
Mailing Address - Phone:320-632-3166
Mailing Address - Fax:320-632-3297
Practice Address - Street 1:103 6TH ST NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-2854
Practice Address - Country:US
Practice Address - Phone:320-632-3166
Practice Address - Fax:320-632-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN804331-2-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty