Healthcare Provider Details

I. General information

NPI: 1174442636
Provider Name (Legal Business Name): BOTH& COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 PARKLAWN AVE STE 110
EDINA MN
55435-5125
US

IV. Provider business mailing address

7600 PARKLAWN AVE STE 110
EDINA MN
55435-5125
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-4714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA LARSON
Title or Position: THERAPIST
Credential: LICSW
Phone: 507-236-3186