Organization
COMMUNITY COUNSELING CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE HIERL (OFFICE MANAGER)
(952) 258-0668
Entity
Organization
Contact information
Practice address
700 TWELVE OAKS CENTER DR, STE. 734, WAYZATA, MN 55391-4401
(952) 258-0668
(612) 235-3384
Mailing address
16725 12TH AVE N, PLYMOUTH, MN 55447-3001
(763) 473-3692
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1597
MN
Other
Enumeration date
10/26/2006
Last updated
08/22/2020
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