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NPI Code Detail

MEDICARE: MRS. LYNNDELLE KRISTIN PRATT M.S., LMFT

MEDICARE: MRS. LYNNDELLE KRISTIN PRATT M.S., LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist2004MN

General Provider Information

NPI Number : 1073837795
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYNNDELLE KRISTIN PRATT M.S., LMFT
Provider Business Mailing Address
First Line : 7600 BOONE AVE N STE 2
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55428-1089
Country : US
Telephone Number : 763-504-8458
Fax Number :
Provider Business Practice Location Address
First Line : 7600 BOONE AVE N
Second Line : SUITE 2
City : BROOKLYN PARK
State : MN
Zip : 55428-4563
Country : US
Telephone Number : 763-504-8458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2010
Last Update Date : 06/30/2011

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