Healthcare Provider Details

I. General information

NPI: 1992934392
Provider Name (Legal Business Name): MORNINGSONG THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W. DIAMOND LAKE ROAD
MINNEAPOLIS MN
55419
US

IV. Provider business mailing address

25 W. DIAMOND LAKE ROAD
MINNEAPOLIS MN
55419
US

V. Phone/Fax

Practice location:
  • Phone: 612-787-5121
  • Fax: 612-437-4795
Mailing address:
  • Phone: 612-787-5121
  • Fax: 612-437-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1600
License Number StateMN

VIII. Authorized Official

Name: LISA KAREN HILL
Title or Position: OWNER/PRESIDENT
Credential: LMFT
Phone: 612-787-5121