Provider Demographics
NPI:1831461813
Name:NORTH WOODS CHRISTIAN COUNSELING, LLC
Entity Type:Organization
Organization Name:NORTH WOODS CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, MDIV
Authorized Official - Phone:651-243-2484
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:WILLERNIE
Mailing Address - State:MN
Mailing Address - Zip Code:55090-0643
Mailing Address - Country:US
Mailing Address - Phone:651-243-2484
Mailing Address - Fax:
Practice Address - Street 1:752 STILLWATER RD STE D
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-2060
Practice Address - Country:US
Practice Address - Phone:651-243-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty