Professional Counseling & Grief Services Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

05559 Issued in MN

Legal business name

PROFESSIONAL COUNSELING & GRIEF SERVICES INC

Practice address

14985 Glazier Ave
Suite 555
Apple Valley, MN 55124-7484

Phone

(952) 891-2525

Fax

(952) 891-1800

NPI assigned

Sep 22, 2010

Organization subpart

No

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

Authorized official

Name

Brenda J Demotte, MSW, LICSW

Title

Owner/Provider

Phone

(952) 891-2525

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1508174681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14985 GLAZIER AVE",
            "address_2": "SUITE 555",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247484",
            "telephone_number": "952-891-2525",
            "fax_number": "952-891-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14985 GLAZIER AVE",
            "address_2": "SUITE 555",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247484",
            "telephone_number": "952-891-2525",
            "fax_number": "952-891-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL COUNSELING & GRIEF SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "DEMOTTE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "952-891-2525",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "05559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.