Collaborative Restoration Counseling Services, LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2619 Issued in MN

Legal business name

COLLABORATIVE RESTORATION COUNSELING SERVICES, LLC

Practice address

15252 W Freeway Dr NE
Suite 1
Forest Lake, MN 55025-8120

Phone

(612) 275-3517

NPI assigned

Oct 10, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Laura Janelle McDermott, LMFT

Title

Founder/Ownder

Phone

(612) 275-3517

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1699102434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 CAHILL RD",
            "address_2": "216C",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392734",
            "telephone_number": "612-275-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15252 W FREEWAY DR NE",
            "address_2": "SUITE 1",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550258120",
            "telephone_number": "612-275-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE RESTORATION COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "JANELLE",
        "authorized_official_title_or_position": "FOUNDER/OWNDER",
        "authorized_official_telephone_number": "612-275-3517",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; 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.