Healthcare Provider Details

I. General information

NPI: 1396424446
Provider Name (Legal Business Name): YOUR STORY MATTERS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 PENN AVE S STE 7-1055
MINNEAPOLIS MN
55423-1186
US

IV. Provider business mailing address

500 W SILVER SPRING DR STE K320
MILWAUKEE WI
53217-0001
US

V. Phone/Fax

Practice location:
  • Phone: 218-332-4771
  • Fax:
Mailing address:
  • Phone: 218-332-4771
  • Fax: 612-486-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON MARTINA RAPALO MEDINA
Title or Position: OWNER
Credential: LICSW
Phone: 612-293-0635