Organization
COMMUNITY OUTREACH COUNSELING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY R JOHNSON MA LMFT (OWNER)
(320) 905-0795
Entity
Organization
Contact information
Practice address
1617 HIGHWAY 12 E, SUITE 230, WILLMAR, MN 56201-5814
(320) 905-0795
(320) 205-0030
Mailing address
1617 HIGHWAY 12 E, SUITE 230, WILLMAR, MN 56201-5814
(320) 905-0795
(320) 205-0030
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1071
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168211300
—
MN
Enumeration date
04/08/2013
Last updated
09/03/2013
Update your record
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