Healthcare Provider Details

I. General information

NPI: 1699454512
Provider Name (Legal Business Name): COMPASSION CLINIC THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 03/16/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 JORDAN AVE S APT 202
MINNETONKA MN
55305-3504
US

IV. Provider business mailing address

2828 JORDAN AVE S APT 202
MINNETONKA MN
55305-3504
US

V. Phone/Fax

Practice location:
  • Phone: 651-728-6400
  • Fax:
Mailing address:
  • Phone: 651-728-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TYLER REKOWSKI
Title or Position: OWNER/PROFESSIONAL THERAPIST
Credential:
Phone: 651-728-6400