| Granite City Counseling, Llc | |
|
250 7th Ave N Waite Park MN 56387-1152 | |
| (320) 257-1800 | |
| (320) 257-1801 |
| Full Name | Granite City Counseling, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 250 7th Ave N, Waite Park, Minnesota |
| Authorized Official Name and Position | Chad Michael Bosl (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3202571800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Granite City Counseling, Llc 250 7th Ave N Waite Park MN 56387-1152 Ph: (320) 257-1800 | Granite City Counseling, Llc 250 7th Ave N Waite Park MN 56387-1152 Ph: (320) 257-1800 |
| NPI Number | 1699943209 |
|---|---|
| Provider Enumeration Date | 02/15/2008 |
| Last Update Date | 10/28/2020 |
| Certification Date | 10/28/2020 |
| Medicare PECOS PAC ID | 8224196332 |
|---|---|
| Medicare Enrollment ID | O20081018000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699943209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP2823 (Minnesota) | Primary |
| Provider Name | Dorothy T Soukup |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497846950 PECOS PAC ID: 4981654316 Enrollment ID: I20050124001027 |
| Provider Name | Dawn M Kuhl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417157553 PECOS PAC ID: 0749427946 Enrollment ID: I20130507000487 |
| Provider Name | Roxann J Storms |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730527367 PECOS PAC ID: 3779710371 Enrollment ID: I20131205000427 |
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