Provider Demographics
NPI:1013467299
Name:SET FREE CHRISTIAN FELLOWSHIP
Entity Type:Organization
Organization Name:SET FREE CHRISTIAN FELLOWSHIP
Other - Org Name:SET FREE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVEREND / PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:REV, MA, LPCC
Authorized Official - Phone:507-227-6806
Mailing Address - Street 1:808 WATER ST SW
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1230
Mailing Address - Country:US
Mailing Address - Phone:507-227-6806
Mailing Address - Fax:
Practice Address - Street 1:808 WATER ST SW
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1230
Practice Address - Country:US
Practice Address - Phone:507-227-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty