Healthcare Provider Details

I. General information

NPI: 1467122804
Provider Name (Legal Business Name): ABUNDANT PEACE COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 OLD SIBLEY MEMORIAL HWY
EAGAN MN
55122-1996
US

IV. Provider business mailing address

3763 DENMARK TRL W
EAGAN MN
55123-1010
US

V. Phone/Fax

Practice location:
  • Phone: 612-888-3858
  • Fax: 888-425-4826
Mailing address:
  • Phone: 651-683-0000
  • Fax: 888-425-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PROEBSTLE
Title or Position: PRESIDENT
Credential: MA, LPCC
Phone: 651-683-0000