Healthcare Provider Details

I. General information

NPI: 1285598219
Provider Name (Legal Business Name): BEATRIZ CARRILLO HERRERA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 UNIVERSITY AVE E
SAINT PAUL MN
55130-4400
US

IV. Provider business mailing address

402 UNIVERSITY AVE E
SAINT PAUL MN
55130-4400
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-3546
  • Fax:
Mailing address:
  • Phone: 651-266-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4829
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: