Healthcare Provider Details

I. General information

NPI: 1992282552
Provider Name (Legal Business Name): AYSEM RUCHAN SENYUREKLI PHD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 COMO AVE
SAINT PAUL MN
55108-1737
US

IV. Provider business mailing address

1295 BANDANA BLVD N
SAINT PAUL MN
55108-5126
US

V. Phone/Fax

Practice location:
  • Phone: 888-364-5977
  • Fax: 844-385-4630
Mailing address:
  • Phone: 888-364-5977
  • Fax: 844-385-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3021
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: