Lake Superior Counseling Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LAKE SUPERIOR COUNSELING CENTER

Practice address

324 W Superior St Ste 915
Duluth, MN 55802-1837

Phone

(218) 464-6753

Fax

(218) 464-6753

NPI assigned

Dec 18, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mari Trine, LICSWNPI 1689044620

Title

Owner

Phone

(218) 590-3506

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mari Trine, LICSW

  • Clinical Social Worker
  • Duluth, MN
  • NPI 1689044620
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1134715618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST STE 915",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021837",
            "telephone_number": "218-464-6753",
            "fax_number": "218-464-6753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST STE 915",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021837",
            "telephone_number": "218-464-6753",
            "fax_number": "218-464-6753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUPERIOR COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-18",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "TRINE",
        "authorized_official_first_name": "MARI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-590-3506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689044620",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Superior College Dental Clinic
• Lake Superior Community Health Center
• Lake Superior Community Health Center
• Lake Superior Community Health Center
• Lake Superior Concierge, Inc.
• Lake Superior Dental Associates
• Lake Superior Internal Medicine
• Lake Superior Medical Equipment Inc
• Lake Superior Physical Therapy Inc
• Lake Vision PLLC

• Community/Behavioral Health Agency in Duluth, MN
• Providers in Duluth, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.