Provider Demographics
NPI:1144318189
Name:TAMARIX COUNSELING SERVICES PA
Entity type:Organization
Organization Name:TAMARIX COUNSELING SERVICES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:BLOMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-363-8877
Mailing Address - Street 1:12533 355TH ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-8736
Mailing Address - Country:US
Mailing Address - Phone:320-363-8877
Mailing Address - Fax:320-363-8821
Practice Address - Street 1:12533 355TH ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MN
Practice Address - Zip Code:56310-8736
Practice Address - Country:US
Practice Address - Phone:320-363-8877
Practice Address - Fax:320-363-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6485LICSW104100000X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN434M2SCOtherBLUE CROSS BLUE SHIELD
MN434M1SCOtherBLUE CROSS BLUE SHIELD
MN6203572OtherMEDICA/UBH
MNHP27100OtherHEALTH PARTNERS