Provider Demographics
NPI:1588254163
Name:RISE UP PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:RISE UP PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOS-TOLLEFSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:320-322-5122
Mailing Address - Street 1:1100 HOLSTEIN DR NE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1464
Mailing Address - Country:US
Mailing Address - Phone:320-322-5122
Mailing Address - Fax:844-990-4122
Practice Address - Street 1:1100 HOLSTEIN DR NE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1464
Practice Address - Country:US
Practice Address - Phone:320-322-5122
Practice Address - Fax:844-990-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty