Healthcare Provider Details

I. General information

NPI: 1407617814
Provider Name (Legal Business Name): ONE GOAT THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 27TH AVE S STE 250
MINNEAPOLIS MN
55406-1565
US

IV. Provider business mailing address

2637 27TH AVE S STE 250
MINNEAPOLIS MN
55406-1565
US

V. Phone/Fax

Practice location:
  • Phone: 612-735-0061
  • Fax:
Mailing address:
  • Phone: 651-301-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN DRAKE RICE
Title or Position: SOMATIC PSYCHOTHERAPIST
Credential: LPCC, RSMT
Phone: 612-735-0061