Provider Demographics
NPI:1912098070
Name:FAMILY CIRCLE COUNSELING PLLC
Entity type:Organization
Organization Name:FAMILY CIRCLE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LMFT
Authorized Official - Phone:651-646-1488
Mailing Address - Street 1:348 PRIOR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5187
Mailing Address - Country:US
Mailing Address - Phone:651-646-1488
Mailing Address - Fax:651-646-2285
Practice Address - Street 1:348 PRIOR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5187
Practice Address - Country:US
Practice Address - Phone:651-646-1488
Practice Address - Fax:651-646-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN035991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty