Healthcare Provider Details

I. General information

NPI: 1154242584
Provider Name (Legal Business Name): C3 MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MINNESOTA AVE W # 101
WALKER MN
56484-2296
US

IV. Provider business mailing address

PO BOX 250
WALKER MN
56484-0250
US

V. Phone/Fax

Practice location:
  • Phone: 612-799-4274
  • Fax:
Mailing address:
  • Phone: 612-799-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELLE COTTER
Title or Position: PRACTICE OWNER
Credential: MA, LMFT
Phone: 612-799-4274