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General NPI Number Information
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NPI Number | 1174335475
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Entity Type | Organization
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Legal Business Name | STONE PATH THERAPY LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 925 PAYNE AVE STE B2
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City | SAINT PAUL
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State | MN
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Zip | 55130-4280
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Country | US
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Telephone | 612-444-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 7974 BLANCHARD CT
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-2944
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Country | US
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Telephone | 320-492-5725
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Fax |
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Authorized Official
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Title or Position | OWNER, MENTAL HEALTH THERAPIST
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Name | TAYLOR LESLIE
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Credential | MA, LPCC
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Telephone | 320-492-5725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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