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General NPI Number Information
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NPI Number | 1306584354
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Entity Type | Organization
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Legal Business Name | THERAPY GLOW MENTAL HEALTH & CONSULTING, PLLC
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 658 E 143RD ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-4609
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Country | US
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Telephone | 612-386-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 658 E 143RD ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-4609
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Country | US
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Telephone | 612-386-3588
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Fax |
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Authorized Official
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Title or Position | CEO / OUTPATIENT PSYCHOTHERAPIST
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Name | MS. VENUS L BURNEY
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Credential | MSW, LICSW
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Telephone | 612-386-3588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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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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