Provider Demographics
NPI:1285079210
Name:AGAPE CHRISTIAN COUNSELING, LLC
Entity type:Organization
Organization Name:AGAPE CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NYHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-862-2211
Mailing Address - Street 1:791 139TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4002
Mailing Address - Country:US
Mailing Address - Phone:763-862-2211
Mailing Address - Fax:763-258-2211
Practice Address - Street 1:791 139TH LN NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4002
Practice Address - Country:US
Practice Address - Phone:763-862-2211
Practice Address - Fax:763-862-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN159351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty