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General NPI Number Information
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NPI Number | 1467800201
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Entity Type | Organization
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Legal Business Name | CONGRUENCY PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 9733 KENT AVE
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City | MONTGOMERY
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State | MN
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Zip | 56069-4903
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Country | US
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Telephone | 612-227-9310
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Fax |
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Provider Business Mailing Address
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Address Line | 9733 KENT AVE
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City | MONTGOMERY
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State | MN
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Zip | 56069-4903
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Country | US
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Telephone | 612-227-9310
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MS. KATHRYN R LANGDON
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Credential | MA, MSW, LICSW
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Telephone | 507-744-4272
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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 | 20331
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License Number State | MN
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