| Community Outreach Counseling Pc | |
|
1617 Highway 12 E Suite 230 Willmar MN 56201-5814 | |
| (320) 905-0795 | |
| (320) 205-0030 |
| Full Name | Community Outreach Counseling Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1617 Highway 12 E, Willmar, Minnesota |
| Authorized Official Name and Position | Timothy R Johnson (OWNER) |
| Authorized Official Contact | 3209050795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Outreach Counseling Pc 1617 Highway 12 E Suite 230 Willmar MN 56201-5814 Ph: (320) 905-0795 | Community Outreach Counseling Pc 1617 Highway 12 E Suite 230 Willmar MN 56201-5814 Ph: (320) 905-0795 |
| NPI Number | 1245673482 |
|---|---|
| Provider Enumeration Date | 04/08/2013 |
| Last Update Date | 09/03/2013 |
| Medicare PECOS PAC ID | 1557581543 |
|---|---|
| Medicare Enrollment ID | O20140925000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245673482 | NPI | - | NPPES |
| 168211300 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1071 (Minnesota) | Primary |
| Provider Name | Alisa R Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598475212 PECOS PAC ID: 8022455286 Enrollment ID: I20240322003329 |
| Provider Name | Timothy Roger Johnson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1699864660 PECOS PAC ID: 2466672456 Enrollment ID: I20240329002266 |
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