Provider Demographics
NPI:1659192292
Name:UP NORTH COUNSELING LLC
Entity type:Organization
Organization Name:UP NORTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:STADSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-984-0989
Mailing Address - Street 1:2101 N LAKEWOOD DR STE 225
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2473
Mailing Address - Country:US
Mailing Address - Phone:208-984-0989
Mailing Address - Fax:208-601-6133
Practice Address - Street 1:2101 N LAKEWOOD DR STE 225
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2473
Practice Address - Country:US
Practice Address - Phone:208-984-0989
Practice Address - Fax:208-601-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health