Healthcare Provider Details

I. General information

NPI: 1144793878
Provider Name (Legal Business Name): NORTHERN CITIES THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN ST NW STE 1
ELK RIVER MN
55330-1542
US

IV. Provider business mailing address

16330 ROYAL RD
RAMSEY MN
55303-8027
US

V. Phone/Fax

Practice location:
  • Phone: 763-438-4971
  • Fax:
Mailing address:
  • Phone: 763-438-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CINDY MEYER
Title or Position: OWNER/PRESIDENT
Credential: MA, LMFT, LADC
Phone: 763-438-4971