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General NPI Number Information
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NPI Number | 1497880108
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Entity Type | Organization
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Legal Business Name | ERVIN COUNSELING AND FAMILY LIFE MINISTRIES, P.A.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 05/04/2024
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Provider Practice Location Address
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Address Line | 7400 METRO BLVD STE 220
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City | EDINA
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State | MN
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Zip | 55439-2321
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Country | US
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Telephone | 952-345-4510
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Fax | 952-345-4518
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Provider Business Mailing Address
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Address Line | 7400 METRO BLVD STE 220
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City | EDINA
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State | MN
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Zip | 55439-2321
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Country | US
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Telephone | 952-345-4510
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Fax | 952-345-4518
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE DAVID ERVIN
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Credential | LMFT
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Telephone | 952-345-4510
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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 | 1114
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License Number State | MN
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