Healthcare Provider Details

I. General information

NPI: 1114544087
Provider Name (Legal Business Name): HONG FA THAO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 BASS LAKE RD STE 255
NEW HOPE MN
55428-3019
US

IV. Provider business mailing address

7625 METRO BLVD STE 200
MINNEAPOLIS MN
55439-3079
US

V. Phone/Fax

Practice location:
  • Phone: 763-225-4052
  • Fax: 888-965-5130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC02503
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: