Provider Demographics
NPI:1801077417
Name:EPONA COUNSELING CENTER LLC
Entity type:Organization
Organization Name:EPONA COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LUNDSTROM
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:6123-990-6232
Mailing Address - Street 1:220 ASHLAND ST S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1542
Mailing Address - Country:US
Mailing Address - Phone:612-390-6232
Mailing Address - Fax:763-689-9755
Practice Address - Street 1:220 ASHLAND ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1542
Practice Address - Country:US
Practice Address - Phone:612-390-6232
Practice Address - Fax:763-689-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty