Healthcare Provider Details

I. General information

NPI: 1003555046
Provider Name (Legal Business Name): TANGLEFISH EMOTIONAL HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 RAYMOND AVE STE 300
SAINT PAUL MN
55114-1525
US

IV. Provider business mailing address

821 RAYMOND AVE STE 300
SAINT PAUL MN
55114-1525
US

V. Phone/Fax

Practice location:
  • Phone: 612-213-4510
  • Fax: 612-361-5464
Mailing address:
  • Phone: 612-213-4510
  • Fax: 612-361-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA E GREY
Title or Position: OWNER
Credential: MSW LICSW
Phone: 612-213-4510