Provider Demographics
NPI:1285740217
Name:ROGERS COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:ROGERS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MORI
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:763-428-6330
Mailing Address - Street 1:21000 ROGERS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4652
Mailing Address - Country:US
Mailing Address - Phone:763-428-6330
Mailing Address - Fax:763-428-6314
Practice Address - Street 1:14165 JAMES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9317
Practice Address - Country:US
Practice Address - Phone:763-428-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO 4192Medicare ID - Type Unspecified