Healthcare Provider Details

I. General information

NPI: 1316405202
Provider Name (Legal Business Name): Q COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2019
Last Update Date: 03/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 WILSHIRE PL NE
MINNEAPOLIS MN
55418-1447
US

IV. Provider business mailing address

1156 PIKE LAKE CIR
SAINT PAUL MN
55112-6404
US

V. Phone/Fax

Practice location:
  • Phone: 218-428-3495
  • Fax:
Mailing address:
  • Phone: 218-428-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL M BECKER-WARNER
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 218-428-3495