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General NPI Number Information
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NPI Number | 1487034815
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Entity Type | Organization
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Legal Business Name | TAKE FLIGHT COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 1821 UNIVERSITY AVE W SUITE# S303
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City | SAINT PAUL
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State | MN
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Zip | 55104-2801
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Country | US
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Telephone | 612-554-9661
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Fax | 612-328-9555
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Provider Business Mailing Address
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Address Line | 4318 34TH AVENUE SOUTH
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City | MINNEAPOLIS
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State | MN
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Zip | 55406
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Country | US
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Telephone | 612-554-9661
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Fax | 612-328-9555
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Authorized Official
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Title or Position | OWNER
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Name | CONSTANCE LORAINE BENNETT
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Credential | LPCC
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Telephone | 612-554-9661
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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 | 00607
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License Number State | MN
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