Healthcare Provider Details

I. General information

NPI: 1285131359
Provider Name (Legal Business Name): HEATHER M CASSIDY MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER BRINKMAN MS, LPC

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 AMERICAN BLVD E STE 550
BLOOMINGTON MN
55425-1139
US

IV. Provider business mailing address

7401 METRO BLVD STE 250
EDINA MN
55439-3062
US

V. Phone/Fax

Practice location:
  • Phone: 612-268-5858
  • Fax: 612-268-5868
Mailing address:
  • Phone: 612-268-5858
  • Fax: 612-268-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2251
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: