Provider Demographics
NPI:1841509247
Name:CEDAR FOREST CHRISTIAN COUNSELING CLINIC
Entity type:Organization
Organization Name:CEDAR FOREST CHRISTIAN COUNSELING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTELA-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:612-240-4203
Mailing Address - Street 1:5100 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE#231C
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3000
Mailing Address - Country:US
Mailing Address - Phone:612-240-4203
Mailing Address - Fax:
Practice Address - Street 1:5100 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:SUITE#231C
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3000
Practice Address - Country:US
Practice Address - Phone:612-240-4203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty