Healthcare Provider Details

I. General information

NPI: 1508549783
Provider Name (Legal Business Name): BRIAN CURTIS LONDON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 WAYZATA BLVD STE 200
MINNETONKA MN
55305-1810
US

IV. Provider business mailing address

200 NATHAN LN N APT 211
PLYMOUTH MN
55441-6470
US

V. Phone/Fax

Practice location:
  • Phone: 952-206-2040
  • Fax: 952-206-2041
Mailing address:
  • Phone: 612-716-7061
  • Fax: 763-316-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2047
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC02047
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: