Healthcare Provider Details

I. General information

NPI: 1568098614
Provider Name (Legal Business Name): TRUE CHANGE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 EDEN AVE STE 318
EDINA MN
55436-2370
US

IV. Provider business mailing address

4225 DREW AVE N
ROBBINSDALE MN
55422-1549
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-6626
  • Fax:
Mailing address:
  • Phone: 763-746-6626
  • Fax:

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: TRACY RONNING
Title or Position: OWNER
Credential: LMFT
Phone: 763-746-6626