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General NPI Number Information
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NPI Number | 1467122804
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Entity Type | Organization
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Legal Business Name | ABUNDANT PEACE COUNSELING PC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 4141 OLD SIBLEY MEMORIAL HWY
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City | EAGAN
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State | MN
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Zip | 55122-1996
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Country | US
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Telephone | 612-888-3858
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Fax | 888-425-4826
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Provider Business Mailing Address
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Address Line | 3763 DENMARK TRL W
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City | EAGAN
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State | MN
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Zip | 55123-1010
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Country | US
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Telephone | 651-683-0000
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Fax | 888-425-4826
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL PROEBSTLE
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Credential | MA, LPCC
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Telephone | 651-683-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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