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General NPI Number Information
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NPI Number | 1043330335
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Entity Type | Organization
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Legal Business Name | DMA CONSULTING LLC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24799 FOREST BLVD
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City | FOREST LAKE
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State | MN
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Zip | 55025-7215
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Country | US
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Telephone | 651-257-4406
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Fax | 651-257-4406
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Provider Business Mailing Address
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Address Line | PO BOX 536
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City | FOREST LAKE
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State | MN
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Zip | 55025-0536
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Country | US
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Telephone | 651-257-4406
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Fax | 651-257-4406
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DAVID MICHAEL ANDERSON
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Credential | D.MIN.
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Telephone | 651-257-4406
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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 | 1061
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License Number State | MN
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