Provider Demographics
NPI:1952841413
Name:PRAIRIE FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:PRAIRIE FAMILY COUNSELING, LLC
Other - Org Name:PRAIRIE FAMILY COUNSELING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRYS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-766-7685
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-2223
Mailing Address - Country:US
Mailing Address - Phone:507-766-7685
Mailing Address - Fax:507-216-6600
Practice Address - Street 1:210 20TH ST S
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073
Practice Address - Country:US
Practice Address - Phone:507-766-7685
Practice Address - Fax:507-216-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN802944000Medicaid
MNH400186196Medicare PIN