Healthcare Provider Details

I. General information

NPI: 1346821063
Provider Name (Legal Business Name): ANDREW WORTHING MS, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 EARLE BROWN DR STE 420
BROOKLYN CENTER MN
55430-2562
US

IV. Provider business mailing address

6040 EARLE BROWN DR STE 420
BROOKLYN CENTER MN
55430-2562
US

V. Phone/Fax

Practice location:
  • Phone: 612-860-8175
  • Fax:
Mailing address:
  • Phone: 612-860-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4001
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: