Healthcare Provider Details

I. General information

NPI: 1881780906
Provider Name (Legal Business Name): PAUL NATHAN READ LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 COLUMBUS AVE
MINNEAPOLIS MN
55407-3526
US

IV. Provider business mailing address

4508 COLUMBUS AVE
MINNEAPOLIS MN
55407-3526
US

V. Phone/Fax

Practice location:
  • Phone: 612-462-0573
  • Fax:
Mailing address:
  • Phone: 612-462-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1299
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: