Healthcare Provider Details

I. General information

NPI: 1659518819
Provider Name (Legal Business Name): SEXUAL HEALTH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WILLOW ST STE 400
MINNEAPOLIS MN
55403-3251
US

IV. Provider business mailing address

1409 WILLOW ST STE 400
MINNEAPOLIS MN
55403-3251
US

V. Phone/Fax

Practice location:
  • Phone: 612-987-4482
  • Fax: 612-872-2205
Mailing address:
  • Phone: 612-987-4482
  • Fax: 612-872-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLP3347
License Number StateMN

VIII. Authorized Official

Name: WESTON EDWARDS
Title or Position: OWNER
Credential: PHD, LP
Phone: 612-987-4482