Provider Demographics
NPI:1790356186
Name:FERN COUNSELING PLLC
Entity Type:Organization
Organization Name:FERN COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-226-6156
Mailing Address - Street 1:3933 EWING AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1053
Mailing Address - Country:US
Mailing Address - Phone:763-222-5327
Mailing Address - Fax:612-223-5633
Practice Address - Street 1:3947 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4755
Practice Address - Country:US
Practice Address - Phone:763-222-5327
Practice Address - Fax:612-223-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty