Healthcare Provider Details

I. General information

NPI: 1750143442
Provider Name (Legal Business Name): BEARS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 LANCASTER LN
EAGAN MN
55122-2720
US

IV. Provider business mailing address

1581 LANCASTER LN
EAGAN MN
55122-2720
US

V. Phone/Fax

Practice location:
  • Phone: 612-227-0971
  • Fax: 651-391-2072
Mailing address:
  • Phone: 612-227-0971
  • Fax: 651-391-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TARAH L GROETTUM
Title or Position: OWNER/PROVIDER
Credential: MSED, LPCC
Phone: 612-227-0971