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General NPI Number Information
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NPI Number | 1336799154
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Entity Type | Organization
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Legal Business Name | NORTHEAST PSYCHOTHERAPY
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 1224 2ND ST NE # 200
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1130
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Country | US
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Telephone | 612-408-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 PIERCE TER NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-1845
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Country | US
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Telephone | 612-408-5004
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | MR. CODY LEWIS OAKS
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Credential | LPCC
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Telephone | 612-408-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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