Provider Demographics
NPI:1053796912
Name:COUNSELING SERVICES OF BEMIDJI
Entity type:Organization
Organization Name:COUNSELING SERVICES OF BEMIDJI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DANNIELLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:952-607-0767
Mailing Address - Street 1:403 4TH ST NW
Mailing Address - Street 2:#110
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3142
Mailing Address - Country:US
Mailing Address - Phone:952-607-0767
Mailing Address - Fax:
Practice Address - Street 1:403 4TH ST NW
Practice Address - Street 2:#110
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3142
Practice Address - Country:US
Practice Address - Phone:952-607-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty