| Organization Name: | TWO OTTERS COUNSELING CENTER, LLC |
| NPI Number: | 1033360524 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SKYE V PAYNE (LICENSED PSYCHOLOGIST) |
| Mailing Address: | 101 W Highway 61 #60 Grand Marais |
| State: | MN US |
| Postal Code: | 556042333 |
| Phone Number: | 2183879133 |
| Fax Number: | 2183879197 |
| NPI Enumeration Date: | 10/02/2008 |
| NPI Last Update Date: | 10/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP2413 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |