MEDICARE: BETH RENNEE MA, 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
1	106H00000X	Marriage & Family Therapist	4233	MN

General Provider Information

NPI Number	:	1770008476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH RENNEE MA, LMFT

Provider Business Mailing Address
First Line	:	2125 E HENNEPIN AVE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1763
Country	:	US
Telephone Number	:	651-262-9515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 E HENNEPIN AVE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1763
Country	:	US
Telephone Number	:	651-262-9515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	12/15/2021

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