Healthcare Provider Details

I. General information

NPI: 1306448097
Provider Name (Legal Business Name): VENTURE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 8TH ST
WHITE BEAR LK MN
55110-5722
US

IV. Provider business mailing address

2504 8TH ST
WHITE BEAR LK MN
55110-5722
US

V. Phone/Fax

Practice location:
  • Phone: 651-472-2903
  • Fax:
Mailing address:
  • Phone: 651-472-2903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN HALL
Title or Position: OWNER
Credential: LMFT
Phone: 651-505-0851