Healthcare Provider Details

I. General information

NPI: 1053839928
Provider Name (Legal Business Name): DAVID ALOIS PRASKA JR. MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 78TH ST STE 100
BLOOMINGTON MN
55420-1402
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 952-854-5034
  • Fax: 952-854-5363
Mailing address:
  • Phone: 651-628-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4265
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: