Provider Demographics
NPI:1972852648
Name:ROSEWALK COUNSELING SERVICES
Entity Type:Organization
Organization Name:ROSEWALK COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-701-0946
Mailing Address - Street 1:1811 WEIR DR STE 190
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2292
Mailing Address - Country:US
Mailing Address - Phone:651-738-8561
Mailing Address - Fax:651-730-6657
Practice Address - Street 1:800 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1899
Practice Address - Country:US
Practice Address - Phone:612-701-0946
Practice Address - Fax:651-730-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty