Healthcare Provider Details

I. General information

NPI: 1760620991
Provider Name (Legal Business Name): REBEKAH SUSAN BRANDVOLD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HIGHWAY 169 N STE 220
NEW HOPE MN
55428-4058
US

IV. Provider business mailing address

4900 HIGHWAY 169 N STE 220
NEW HOPE MN
55428-4058
US

V. Phone/Fax

Practice location:
  • Phone: 612-427-8197
  • Fax: 763-762-6911
Mailing address:
  • Phone: 612-716-6795
  • Fax: 763-786-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: