Provider Demographics
NPI:1760646715
Name:BIRCH LAKE COUNSELING LLC
Entity Type:Organization
Organization Name:BIRCH LAKE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORSAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:218-675-5101
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:MN
Mailing Address - Zip Code:56452-0471
Mailing Address - Country:US
Mailing Address - Phone:218-675-5101
Mailing Address - Fax:801-340-9860
Practice Address - Street 1:122 1ST ST. N.
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:MN
Practice Address - Zip Code:56452-0471
Practice Address - Country:US
Practice Address - Phone:218-675-5101
Practice Address - Fax:801-340-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center