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General NPI Number Information
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NPI Number | 1144228776
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Entity Type | Organization
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Legal Business Name | WOODCREST COUNSELING, INC
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 521 TANGLEWOOD DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2016
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Country | US
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Telephone | 763-753-1785
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Fax | 763-753-1753
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Provider Business Mailing Address
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Address Line | 521 TANGLEWOOD DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2016
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Country | US
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Telephone | 763-753-1785
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Fax | 763-753-1753
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Authorized Official
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Title or Position | PSYCHOLOGIST / OWNER
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Name | MR. THOMAS MICHAEL GRASKE
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Credential | M.A., L.P.
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Telephone | 763-753-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP3334
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License Number State | MN
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