Healthcare Provider Details

I. General information

NPI: 1043074131
Provider Name (Legal Business Name): BARBARA WORMINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 COUNTY ROAD 81 STE N
MAPLE GROVE MN
55369-7598
US

IV. Provider business mailing address

10650 COUNTY ROAD 81 STE N
MAPLE GROVE MN
55369-7598
US

V. Phone/Fax

Practice location:
  • Phone: 417-529-3250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2935
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: