Healthcare Provider Details

I. General information

NPI: 1902432230
Provider Name (Legal Business Name): ARDEN SHORES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 HAMLINE AVE N STE 200
ROSEVILLE MN
55113-4226
US

IV. Provider business mailing address

2151 HAMLINE AVE N STE 200
ROSEVILLE MN
55113-5571
US

V. Phone/Fax

Practice location:
  • Phone: 651-583-5565
  • Fax: 651-583-5566
Mailing address:
  • Phone: 651-583-5565
  • Fax: 651-583-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHANNON LYNN RICHMOND
Title or Position: OWNER/THERAPIST
Credential:
Phone: 651-583-5565