Healthcare Provider Details

I. General information

NPI: 1356053284
Provider Name (Legal Business Name): SPRINGWOOD THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 METRO BLVD STE 550
EDINA MN
55439-1300
US

IV. Provider business mailing address

7201 METRO BLVD STE 550
EDINA MN
55439-1300
US

V. Phone/Fax

Practice location:
  • Phone: 651-307-9626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN BRYNN LASCHEN
Title or Position: OWNER
Credential: LPCC
Phone: 651-307-9626