Healthcare Provider Details

I. General information

NPI: 1518963750
Provider Name (Legal Business Name): BURNSVILLE COUNSELING & HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17305 CEDAR AVE. S. SUITE 230
LAKEVILLE MN
55044
US

IV. Provider business mailing address

17305 CEDAR AVE. S. SUITE 230
LAKEVILLE MN
55044
US

V. Phone/Fax

Practice location:
  • Phone: 952-435-4144
  • Fax: 952-435-4149
Mailing address:
  • Phone: 952-435-4144
  • Fax: 952-435-4149

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: PAULA BECKER
Title or Position: PRESIDENT
Credential: MA,LP
Phone: 952-435-4144