Healthcare Provider Details

I. General information

NPI: 1104094135
Provider Name (Legal Business Name): MICHELLE FAITH ABBOTT MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8669 EAGLE POINT BLVD
LAKE ELMO MN
55042-8628
US

IV. Provider business mailing address

4201 EXCELSIOR BLVD
ST LOUIS PARK MN
55416-4728
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-0444
  • Fax: 651-379-0448
Mailing address:
  • Phone: 952-933-8900
  • Fax: 952-945-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: