Provider Demographics
NPI:1538601778
Name:GREAT NORTH COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:GREAT NORTH COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER, PRIMARY CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, LPCC
Authorized Official - Phone:218-214-6096
Mailing Address - Street 1:310 4TH AVE S
Mailing Address - Street 2:STE 5010 PMB 91823
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1053
Mailing Address - Country:US
Mailing Address - Phone:218-214-6096
Mailing Address - Fax:888-972-3614
Practice Address - Street 1:310 4TH AVE S
Practice Address - Street 2:STE 5010 PMB 91823
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1053
Practice Address - Country:US
Practice Address - Phone:218-214-6096
Practice Address - Fax:888-972-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304598101YA0400X
MN1892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty