Healthcare Provider Details

I. General information

NPI: 1750675104
Provider Name (Legal Business Name): SPIEGEL PSYCHOTHERAPY SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CLEVELAND AVE S 207A
SAINT PAUL MN
55116-3858
US

IV. Provider business mailing address

790 CLEVELAND AVE S 207A
SAINT PAUL MN
55116-3858
US

V. Phone/Fax

Practice location:
  • Phone: 612-805-7420
  • Fax: 651-690-0968
Mailing address:
  • Phone: 612-805-7420
  • Fax: 651-690-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number301154
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1942
License Number StateMN

VIII. Authorized Official

Name: MS. RUTH A SPIEGEL
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: MA LMFT LADC
Phone: 612-805-7420