Healthcare Provider Details

I. General information

NPI: 1669329280
Provider Name (Legal Business Name): AZURE COLLABORATIVE COUNSELING & CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 SUMMIT DR N STE 200-9426
BROOKLYN CENTER MN
55430-2118
US

IV. Provider business mailing address

6160 SUMMIT DR N STE 200-9426
BROOKLYN CENTER MN
55430-2118
US

V. Phone/Fax

Practice location:
  • Phone: 612-310-7929
  • Fax:
Mailing address:
  • Phone: 612-310-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AZURE INGRAM-BOYNTON
Title or Position: OWNER
Credential: LMFT
Phone: 612-310-7929