Healthcare Provider Details

I. General information

NPI: 1629541644
Provider Name (Legal Business Name): MICHAEL PT CAIN MA, LPCC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 INWOOD AVE N
SAINT PAUL MN
55128-6625
US

IV. Provider business mailing address

992 INWOOD AVE N
SAINT PAUL MN
55128-6625
US

V. Phone/Fax

Practice location:
  • Phone: 651-472-5915
  • Fax: 651-342-8443
Mailing address:
  • Phone: 651-472-5915
  • Fax: 651-342-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number02774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: