| Birch Lake Professional Counseling Group, Inc. | |
|
1310 Highway 96 E Suite 104b White Bear Lake MN 55110-3624 | |
| (651) 653-1925 | |
| (651) 653-1956 |
| Full Name | Birch Lake Professional Counseling Group, Inc. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1310 Highway 96 E, White Bear Lake, Minnesota |
| Authorized Official Name and Position | Joe William Gladden (MANAGING DIRECTOR) |
| Authorized Official Contact | 6516531925 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Birch Lake Professional Counseling Group, Inc. 1310 Highway 96 E Suite 104b White Bear Lake MN 55110-3624 Ph: (651) 653-1925 | Birch Lake Professional Counseling Group, Inc. 1310 Highway 96 E Suite 104b White Bear Lake MN 55110-3624 Ph: (651) 653-1925 |
| NPI Number | 1386863793 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386863793 | NPI | - | NPPES |
| 00133 | Other | MN | LPC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 00133 (Minnesota) | Primary |
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