Healthcare Provider Details

I. General information

NPI: 1760824486
Provider Name (Legal Business Name): UNION GOSPEL MISSION TWIN CITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 UNIVERSITY AVE E
SAINT PAUL MN
55130-4437
US

IV. Provider business mailing address

435 UNIVERSITY AVE E
SAINT PAUL MN
55130-4437
US

V. Phone/Fax

Practice location:
  • Phone: 651-444-5838
  • Fax:
Mailing address:
  • Phone: 651-444-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARY SEABLOOM
Title or Position: DIRECTOR OF MENTAL HEALTH AND SUPPO
Credential: LP
Phone: 651-444-5838