MEDICARE: CLOUD BREAK PSYCHOTHERAPY LLC

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1174476311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOUD BREAK PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	5500 NICOLLET AVE UNIT 19151
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1982
Country	:	US
Telephone Number	:	218-839-4225
Fax Number	:

Provider Business Practice Location Address
First Line	:	4748 CHICAGO AVE STE 9
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-4320
Country	:	US
Telephone Number	:	218-839-4225
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE & FAMILY THERAPIST
Name	:	JOCELYN SUTEHALL
Credential	:	LMFT
Telephone Number	:	218-839-4225

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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