Healthcare Provider Details

I. General information

NPI: 1801727680
Provider Name (Legal Business Name): FACETS OF WELLNESS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 PLEASANT AVE STE 205
MINNEAPOLIS MN
55409-1279
US

IV. Provider business mailing address

3754 PLEASANT AVE STE 205
MINNEAPOLIS MN
55409-1279
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-2358
  • Fax:
Mailing address:
  • Phone: 612-208-2358
  • Fax:

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: KELLY MILLS
Title or Position: PRACTICE OWNER
Credential: LICSW
Phone: 612-208-2358