Provider Demographics
NPI:1780198309
Name:AMBER PONE COUNSELING
Entity Type:Organization
Organization Name:AMBER PONE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:PONE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:512-363-6365
Mailing Address - Street 1:7400 HALF MOON DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4811
Mailing Address - Country:US
Mailing Address - Phone:512-363-6365
Mailing Address - Fax:
Practice Address - Street 1:1409 WILLOW ST STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3251
Practice Address - Country:US
Practice Address - Phone:512-363-6365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN208771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty