Healthcare Provider Details

I. General information

NPI: 1710526637
Provider Name (Legal Business Name): SHADLYN COX BOURNE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHADLYN COX-BOURNE LPCC

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 BOONE AVE N
NEW HOPE MN
55428-3636
US

IV. Provider business mailing address

3000 AMES CROSSING RD STE 600
EAGAN MN
55121-2570
US

V. Phone/Fax

Practice location:
  • Phone: 651-774-0011
  • Fax: 651-774-0606
Mailing address:
  • Phone: 651-774-0011
  • Fax: 651-774-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2267
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: