| Organization Name: | GRANITE CITY COUNSELING, LLC |
| NPI Number: | 1699943209 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE MARY BOSL (CLINICAL DIRECTOR) |
| Mailing Address: | 818 2nd St S Suite 180 Waite Park |
| State: | MN US |
| Postal Code: | 563874528 |
| Phone Number: | 3202571800 |
| Fax Number: | 3202571801 |
| NPI Enumeration Date: | 02/15/2008 |
| NPI Last Update Date: | 02/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP2823 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |