Healthcare Provider Details

I. General information

NPI: 1083518054
Provider Name (Legal Business Name): THRESHOLD RELATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 16TH AVE SE # 101
MINNEAPOLIS MN
55414-2495
US

IV. Provider business mailing address

1153 16TH AVE SE # 101
MINNEAPOLIS MN
55414-2495
US

V. Phone/Fax

Practice location:
  • Phone: 612-260-8841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAUREN IVESTER TETRAULT
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LICSW
Phone: 612-260-8841