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General NPI Number Information
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NPI Number | 1417699901
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Entity Type | Individual
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Provider Name | TARAH LYNN GROETTUM MSED, LPCC
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Gender | Female
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 1581 LANCASTER LN
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City | EAGAN
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State | MN
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Zip | 55122-2720
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Country | US
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Telephone | 612-227-0971
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Fax | 651-391-2072
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Provider Business Mailing Address
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Address Line | 1581 LANCASTER LN
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City | EAGAN
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State | MN
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Zip | 55122-2720
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Country | US
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Telephone | 612-227-0971
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Fax | 651-391-2072
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC03223
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License Number State | MN
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