Healthcare Provider Details

I. General information

NPI: 1659581411
Provider Name (Legal Business Name): HELEN MARIE PLOURDE MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HELEN MARIE PLOURDE MA

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 PILOT KNOB RD
EAGAN MN
55122-1814
US

IV. Provider business mailing address

1606 HILLCREST AVE
SAINT PAUL MN
55116-2147
US

V. Phone/Fax

Practice location:
  • Phone: 651-690-5202
  • Fax:
Mailing address:
  • Phone: 651-690-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number929
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: