=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063638765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERI STRUTHERS M.A.,NCC, LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 04/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2061 100TH AVE
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55371-6119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-360-2585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8600 261ST AVE NW
-----------------------------------------------------
City | ZIMMERMAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55398-4014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-360-2585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 00102
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------