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General NPI Number Information
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NPI Number | 1477452589
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Entity Type | Organization
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Legal Business Name | PEARL PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 314 CLIFTON AVE STE 106
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3383
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Country | US
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Telephone | 612-367-7802
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Fax |
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Provider Business Mailing Address
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Address Line | 10382 RICH RD
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2505
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Country | US
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Telephone | 612-367-7802
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | NICOLE DUXBURY
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Credential | LICSW
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Telephone | 612-367-7802
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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 |
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License Number State |
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