Provider Demographics
NPI:1962557496
Name:COUNSELING SERVICES OF SOUTHERN MINNESOTA, INC
Entity type:Organization
Organization Name:COUNSELING SERVICES OF SOUTHERN MINNESOTA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NATALEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-931-8040
Mailing Address - Street 1:1306 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4500
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:507-931-8060
Practice Address - Street 1:1306 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-4500
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3791103T00000X
MNLP4430103T00000X
MN110761041C0700X
MN106951041C0700X
MN1290106H00000X
MN1424106H00000X
MN1150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN396R7COOtherBCBS LMFT GROUP #
MN8G343COOtherBCBS LICSW GROUP #
MN065888000Medicaid
MN81D54COOtherBCBS DR LEVEL LP GROUP #
MN934625200Medicaid
MN8G343COOtherBCBS LICSW GROUP #