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General NPI Number Information
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NPI Number | 1013540178
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Entity Type | Organization
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Legal Business Name | RENOVATION COUNSELING, PLLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 620 CIVIC HEIGHTS DR STE 103
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City | CIRCLE PINES
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State | MN
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Zip | 55014-4709
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Country | US
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Telephone | 763-280-7486
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Fax |
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Provider Business Mailing Address
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Address Line | 620 CIVIC HEIGHTS DR STE 103
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City | CIRCLE PINES
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State | MN
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Zip | 55014-4709
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Country | US
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Telephone | 763-280-7486
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | RACHEL JOY LARSON
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Credential | LMFT
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Telephone | 763-280-7486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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