Healthcare Provider Details

I. General information

NPI: 1942692108
Provider Name (Legal Business Name): DAVID HOVIS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 COUNTY ROAD B WEST #204
ROSEVILLE MN
55113
US

IV. Provider business mailing address

1611 COUNTY ROAD B WEST #204
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 612-424-2734
  • Fax: 612-486-9330
Mailing address:
  • Phone: 612-321-8569
  • Fax: 612-486-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3784
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: