Healthcare Provider Details

I. General information

NPI: 1689159840
Provider Name (Legal Business Name): ROLLEN BENJAMIN TWOGOOD LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 SHINGLE CREEK PKWY STE 150
BROOKLYN CENTER MN
55430-2324
US

IV. Provider business mailing address

701 DECATUR AVE N STE 109
GOLDEN VALLEY MN
55427-4363
US

V. Phone/Fax

Practice location:
  • Phone: 763-569-5200
  • Fax: 763-569-5201
Mailing address:
  • Phone: 763-746-2421
  • Fax: 763-746-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2789
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: