Healthcare Provider Details

I. General information

NPI: 1629159678
Provider Name (Legal Business Name): QOL GUIDANCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 NICOLS RD SUITE 102A
EAGAN MN
55122-3336
US

IV. Provider business mailing address

4651 NICOLS RD SUITE 102A
EAGAN MN
55122-3336
US

V. Phone/Fax

Practice location:
  • Phone: 651-688-3168
  • Fax: 651-688-3583
Mailing address:
  • Phone: 651-688-3168
  • Fax: 651-688-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberLADC300273
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3677
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3677
License Number StateMN

VIII. Authorized Official

Name: MS. LINDA K GORDON
Title or Position: OWNER PRESIDENT SOLE EMPLOYEE
Credential: MA LP LADC
Phone: 651-688-3168