Organization
NORTHEAST COUNSELING, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM G SCOTT LICSW (PRESIDENT)
(651) 398-6341
Entity
Organization
Contact information
Practice address
2127 COUNTY ROAD D E STE A100, MAPLEWOOD, MN 55109-5350
(651) 592-1592
(651) 429-2988
Mailing address
2127 COUNTY ROAD D E STE A100, MAPLEWOOD, MN 55109-5350
(651) 592-1592
(651) 429-2988
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053596577
—
MN
Enumeration date
01/03/2008
Last updated
04/02/2018
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