Provider Demographics
NPI:1053285874
Name:FOUR CORNERS COUNSELING LLC
Entity type:Organization
Organization Name:FOUR CORNERS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANNEU
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASSOW
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-990-1567
Mailing Address - Street 1:440 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1243
Mailing Address - Country:US
Mailing Address - Phone:507-990-1567
Mailing Address - Fax:
Practice Address - Street 1:300 3RD AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4681
Practice Address - Country:US
Practice Address - Phone:507-990-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)