Northern Edge Counseling, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

NORTHERN EDGE COUNSELING, LLC

Practice address

394 S Lake Ave Ste 515
Duluth, MN 55802-2325

Phone

(218) 206-6676

NPI assigned

Mar 8, 2024

Organization subpart

No

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

Authorized official

Name

Jaclyn Decorsey, MSW LICSWNPI 1447720248

Title

Psychotherapist

Phone

(218) 206-6676

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaclyn Decorsey

  • Clinical Social Worker
  • Duluth, MN
  • NPI 1447720248
  NPD Authorized official
• Nicole Dorothy Watson, MSW, LICSW

  • Clinical Social Worker
  • Duluth, MN
  • NPI 1043713282
  NPD (past)

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

{
    "created_epoch": "1709856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1598523110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "394 S LAKE AVE STE 515",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022325",
            "telephone_number": "218-206-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 S LAKE AVE STE 515",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022325",
            "telephone_number": "218-206-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN EDGE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-08",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "DECORSEY",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "218-206-6676",
        "authorized_official_credential": "MSW LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northern Access Transportation, Inc
• Northern Arm & Hand Center, Inc.
• Northern Arm & Hand Center, Inc.
• Northern Endodontic Associates, PA
• Northern Foot & Ankle Associates PA
• Northern Imaging of Duluth LLC
• Northern Lakes Chiropractic LLC
• Northern Lives Inc.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Duluth, MN
• Providers in Duluth, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.