Healthcare Provider Details

I. General information

NPI: 1063115632
Provider Name (Legal Business Name): MC CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 62ND AVE N
NEW HOPE MN
55428-2626
US

IV. Provider business mailing address

8701 62ND AVE N
NEW HOPE MN
55428-2626
US

V. Phone/Fax

Practice location:
  • Phone: 651-447-7364
  • Fax:
Mailing address:
  • Phone: 651-447-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARTHA CARTER
Title or Position: MENTAL HEALTH CLINICIAN
Credential: LICSW
Phone: 651-447-7364