Healthcare Provider Details

I. General information

NPI: 1508120841
Provider Name (Legal Business Name): AMY COLLEEN GEBBEN MA, LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ASHLAND ST S
CAMBRIDGE MN
55008-1517
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 651-628-9566
  • Fax: 651-628-0411
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2258
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: