Healthcare Provider Details

I. General information

NPI: 1831875384
Provider Name (Legal Business Name): WEST METRO THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BROADWAY AVE
ROBBINSDALE MN
55422-2211
US

IV. Provider business mailing address

10671 106TH AVE N
HANOVER MN
55341-4400
US

V. Phone/Fax

Practice location:
  • Phone: 612-239-5654
  • Fax:
Mailing address:
  • Phone: 612-239-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JULIE RAE RICHTER
Title or Position: OWNER
Credential: MA, LMFT
Phone: 612-239-5654