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General NPI Number Information
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NPI Number | 1457654188
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Entity Type | Organization
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Legal Business Name | STRONG FOUNDATIONS COUNSELING, LLC
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 303 1ST AVE NE STE 103
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City | FARIBAULT
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State | MN
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Zip | 55021-5373
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Country | US
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Telephone | 507-491-4848
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Fax | 507-331-8677
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Provider Business Mailing Address
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Address Line | 303 1ST AVE NE STE 103
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City | FARIBAULT
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State | MN
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Zip | 55021-5373
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Country | US
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Telephone | 507-491-4848
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Fax | 507-331-8677
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MISTYNE ZACHARIAS
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Credential | LMFT
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Telephone | 507-491-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2239
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License Number State | MN
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