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General NPI Number Information
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NPI Number | 1013551803
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Entity Type | Organization
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Legal Business Name | ASHLEE SECORD MA LMFT
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 11990 PORTLAND AVE
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City | BURNSVILLE
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State | MN
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Zip | 55337-1516
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Country | US
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Telephone | 612-568-6050
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Fax | 952-479-7896
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Provider Business Mailing Address
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Address Line | 11990 PORTLAND AVE
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City | BURNSVILLE
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State | MN
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Zip | 55337-1516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEE NOEL SECORD
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Credential | LMFT
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Telephone | 612-568-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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