Organization
THE BLUE COUCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI BORN EDD, LMFT, RPT-S (OWNER, CEO)
(507) 380-0626
Entity
Organization
Contact information
Practice address
1400 MADISON AVE STE 322, MANKATO, MN 56001-5465
(507) 702-3030
(507) 702-3030
Mailing address
1400 MADISON AVE STE 322, MANKATO, MN 56001-5465
(507) 702-3030
(507) 702-3030
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/13/2022
Last updated
01/13/2023
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