Healthcare Provider Details

I. General information

NPI: 1871228734
Provider Name (Legal Business Name): MORNING STAR PSYCHOTHERAPY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 03/25/2024
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 CARTER AVE STE 9
SAINT PAUL MN
55108-1654
US

IV. Provider business mailing address

2230 CARTER AVE STE 9
SAINT PAUL MN
55108-1654
US

V. Phone/Fax

Practice location:
  • Phone: 612-564-3414
  • Fax:
Mailing address:
  • Phone: 651-245-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA GOODWIN
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 651-245-9901