Healthcare Provider Details

I. General information

NPI: 1245377886
Provider Name (Legal Business Name): TENNISON CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 SAINT PAUL AVE
SAINT PAUL MN
55116-2015
US

IV. Provider business mailing address

897 SAINT PAUL AVE
SAINT PAUL MN
55116-2015
US

V. Phone/Fax

Practice location:
  • Phone: 612-963-7995
  • Fax: 651-698-4817
Mailing address:
  • Phone: 612-963-7995
  • Fax: 651-698-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1377
License Number StateMN

VIII. Authorized Official

Name: MS. DANA MARIE TENNISON
Title or Position: THERAPIST
Credential: LMFT
Phone: 612-963-7995