Healthcare Provider Details

I. General information

NPI: 1508708405
Provider Name (Legal Business Name): FAITHFULLY THRIVING COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 FORD PKWY # 5622
SAINT PAUL MN
55116-2850
US

IV. Provider business mailing address

2136 FORD PKWY # 5622
SAINT PAUL MN
55116-2850
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY LOTT
Title or Position: OWNER
Credential:
Phone: --