# CEDAR BRANCH COUNSELING GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912497348
- **Authorized official:** MARY ELIZABETH CLARK LMFT (PLLC MEMBER, FAMILY THERAPIST)
- **Authorized official phone:** (218) 240-0368

## Contact information

- **Practice address:** 2232 2ND AVE E STE 5, INTERNATIONAL FALLS, MN 56649-4042
- **Practice address phone:** (218) 319-7171
- **Practice address fax:** (218) 260-4749
- **Mailing address:** 2232 2ND AVE E STE 5, INTERNATIONAL FALLS, MN 56649-4042
- **Mailing address phone:** (218) 319-7171
- **Mailing address fax:** (218) 260-4749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | 1267 | MN | — |
| 101YP2500X | Professional Counselor | 1576 | MN | — |
| 106H00000X | Marriage & Family Therapist | 3298 | MN | Yes |
| 106H00000X | Marriage & Family Therapist | 3507 | MN | — |
| 106H00000X | Marriage & Family Therapist | 3514 | MN | — |

## Other

- **Enumeration date:** 05/10/2018
- **Last updated:** 10/13/2023