Provider Demographics
NPI:1053548198
Name:A BRIEF THERAPY CENTER OF ROCHESTER, LLC
Entity type:Organization
Organization Name:A BRIEF THERAPY CENTER OF ROCHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLIEWER
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:507-280-6054
Mailing Address - Street 1:1700 N BROADWAY
Mailing Address - Street 2:SUITE 154
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4144
Mailing Address - Country:US
Mailing Address - Phone:507-280-6054
Mailing Address - Fax:507-280-6010
Practice Address - Street 1:2333 HAWTHORN HILL RD NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-8582
Practice Address - Country:US
Practice Address - Phone:507-280-6054
Practice Address - Fax:507-280-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1526101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty