Cedar Branch Counseling Group, PLLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3298 Issued in MN

Legal business name

CEDAR BRANCH COUNSELING GROUP, PLLC

Practice address

2232 2ND Ave E Ste 5
International Falls, MN 56649-4042

Phone

(218) 319-7171

Fax

(218) 260-4749

NPI assigned

May 10, 2018

Organization subpart

No

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

Authorized official

Name

Mary Elizabeth Clark, LMFTNPI 1689129546

Title

PLLC Member, Family Therapist

Phone

(218) 240-0368

Specialties & licenses 5

Addresses

Electronic endpoints 1

Locations

Practitioners 2

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

• Mary Clark, LMFT

  • Marriage & Family Therapist
  • International Falls, MN
  • NPI 1689129546
  NPD Authorized official
• Amy Colleen Hayes, MA, NCC, LPCC

  • Professional Counselor
  • Hermantown, MN
  • NPI 1215594197
  NPD (past)

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1912497348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 2ND AVE E STE 5",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566494042",
            "telephone_number": "218-319-7171",
            "fax_number": "218-260-4749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 2ND AVE E STE 5",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566494042",
            "telephone_number": "218-319-7171",
            "fax_number": "218-260-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR BRANCH COUNSELING GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PLLC MEMBER, FAMILY THERAPIST",
        "authorized_official_telephone_number": "218-240-0368",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "1267",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "1576",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3298",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3507",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3514",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "FAX",
            "affiliation": "N",
            "endpointDescription": "HIPAA compliant FAX  218-260-4749",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "218-260-4749 FAX",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FAX",
            "address_1": "2232 2nd Ave E Ste 5",
            "city": "International Falls",
            "state": "MN",
            "country_code": "US",
            "postal_code": "566494042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Marriage & Family Therapist in International Falls, MN
• Providers in International Falls, 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 13, 2023; 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.