=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033522040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIRSTEN WEBB COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2014
-----------------------------------------------------
Last Update Date | 06/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7947 S BAY CURV
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55347-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-990-2696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7947 S BAY CURV
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55347-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-990-2696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH THERAPIST
-----------------------------------------------------
Name | MRS. KIRSTEN J WEBB
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 507-990-2696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 17659
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------