Healthcare Provider Details

I. General information

NPI: 1326424896
Provider Name (Legal Business Name): PA T VUE MS., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 SEASONS PKWY STE 105
WOODBURY MN
55125-4393
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-7672
  • Fax: 651-254-0601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2479
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: