Healthcare Provider Details

I. General information

NPI: 1083995922
Provider Name (Legal Business Name): BRIAN PATRICK ZIRNGIBLE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 78TH ST SUITE 318
BLOOMINGTON MN
55420-1400
US

IV. Provider business mailing address

414 S 8TH ST
MINNEAPOLIS MN
55404-1025
US

V. Phone/Fax

Practice location:
  • Phone: 612-670-5848
  • Fax:
Mailing address:
  • Phone: 612-339-9101
  • Fax: 612-341-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2154
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: