Healthcare Provider Details

I. General information

NPI: 1588731400
Provider Name (Legal Business Name): REBECCA CONNOR LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7415 WAYZATA BLVD SUITE 102
ST LOUIS PARK MN
55426
US

IV. Provider business mailing address

13030 12TH AVENUE NORTH SUITE 102
PLYMOUTH MN
55441
US

V. Phone/Fax

Practice location:
  • Phone: 612-877-1081
  • Fax: 763-355-5344
Mailing address:
  • Phone: 612-877-1081
  • Fax: 763-355-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 1036
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: