Healthcare Provider Details

I. General information

NPI: 1255488409
Provider Name (Legal Business Name): BOTH AND RESOURCES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 02/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7493 147TH ST W SUITE 207
APPLE VALLEY MN
55124-4505
US

IV. Provider business mailing address

7493 147TH ST W SUITE 207
APPLE VALLEY MN
55124-4505
US

V. Phone/Fax

Practice location:
  • Phone: 952-432-0043
  • Fax: 952-432-0809
Mailing address:
  • Phone: 952-432-0043
  • Fax: 952-432-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number07587
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0768
License Number StateMN

VIII. Authorized Official

Name: MS. VIRGINIA D'ANGELO
Title or Position: LIC. MARRIAGE AND FAMILY THERAPIST
Credential: LMFT, LICSW
Phone: 952-432-0043