Provider Demographics
NPI:1194298026
Name:REGROUP COUNSELING AND CONSULTING PSC
Entity type:Organization
Organization Name:REGROUP COUNSELING AND CONSULTING PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-350-9687
Mailing Address - Street 1:586 DODGE AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1913
Mailing Address - Country:US
Mailing Address - Phone:763-350-9687
Mailing Address - Fax:651-447-5394
Practice Address - Street 1:18336 JOPLIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1773
Practice Address - Country:US
Practice Address - Phone:763-350-9687
Practice Address - Fax:651-447-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1194298026Medicaid