Provider Demographics
NPI:1699239566
Name:CGC LLC
Entity type:Organization
Organization Name:CGC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:612-642-1754
Mailing Address - Street 1:4208 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4758
Mailing Address - Country:US
Mailing Address - Phone:630-677-5437
Mailing Address - Fax:
Practice Address - Street 1:4208 PARK GLEN RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4758
Practice Address - Country:US
Practice Address - Phone:630-677-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1336374750OtherCLINICAL SOCIAL WORKER
MN1447644224OtherSOCIAL WORKER CLINICAL