Healthcare Provider Details

I. General information

NPI: 1083215420
Provider Name (Legal Business Name): ALISON WULF MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 160TH ST W
LAKEVILLE MN
55044-8348
US

IV. Provider business mailing address

1230 BRYANT AVE APT 8
SOUTH SAINT PAUL MN
55075-1444
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-1133
  • Fax:
Mailing address:
  • Phone: 651-368-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2628
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: