Provider Demographics
NPI:1225588726
Name:MIDWAY COUNSELING, LLC
Entity type:Organization
Organization Name:MIDWAY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:612-656-9394
Mailing Address - Street 1:3441 35TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2740
Mailing Address - Country:US
Mailing Address - Phone:612-656-9394
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:SUITE 410
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:612-656-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty