Provider Demographics
NPI:1316106214
Name:EPIPHANY PLACE
Entity type:Organization
Organization Name:EPIPHANY PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEEDE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN LPC NCC
Authorized Official - Phone:507-532-7326
Mailing Address - Street 1:608 VIKING DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2300
Mailing Address - Country:US
Mailing Address - Phone:507-532-7326
Mailing Address - Fax:
Practice Address - Street 1:100 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHAL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-532-7326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable