Provider Demographics
NPI:1699943209
Name:GRANITE CITY COUNSELING, LLC
Entity type:Organization
Organization Name:GRANITE CITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOSL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:320-257-1800
Mailing Address - Street 1:250 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1152
Mailing Address - Country:US
Mailing Address - Phone:320-257-1800
Mailing Address - Fax:320-257-1801
Practice Address - Street 1:250 7TH AVE N
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1152
Practice Address - Country:US
Practice Address - Phone:320-257-1800
Practice Address - Fax:320-257-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty