Healthcare Provider Details

I. General information

NPI: 1528460193
Provider Name (Legal Business Name): JOYCE POLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 E RIVER RD STE 1
ANOKA MN
55303-1891
US

IV. Provider business mailing address

646 E RIVER RD STE 1
ANOKA MN
55303-1891
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-1950
  • Fax: 763-427-7006
Mailing address:
  • Phone: 763-427-1950
  • Fax: 763-427-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2811
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: