Healthcare Provider Details

I. General information

NPI: 1699100909
Provider Name (Legal Business Name): MARINA JOANNE MITCHELTREE M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3395 PLYMOUTH RD ST. DAVID'S CENTER FOR CHILD & FAMILY DEVELOPMENT
MINNETONKA MN
55305-3765
US

IV. Provider business mailing address

3395 PLYMOUTH RD ST. DAVID'S CENTER FOR CHILD & FAMILY DEVELOPMENT
MINNETONKA MN
55305-3765
US

V. Phone/Fax

Practice location:
  • Phone: 952-939-0396
  • Fax: 952-548-8760
Mailing address:
  • Phone: 952-939-0396
  • Fax: 952-548-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00376
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: