Healthcare Provider Details

I. General information

NPI: 1962285932
Provider Name (Legal Business Name): WHOLISTIC COUNSELING AND COACHING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13750 CROSSTOWN DR NW STE 106
ANDOVER MN
55304-5855
US

IV. Provider business mailing address

2149 126TH AVE NW
COON RAPIDS MN
55448-1568
US

V. Phone/Fax

Practice location:
  • Phone: 763-309-3369
  • Fax:
Mailing address:
  • Phone: 763-309-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNE M CARROLL
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 763-309-3369