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General NPI Number Information
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NPI Number | 1538407150
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Entity Type | Organization
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Legal Business Name | TRACI A VALENTINE
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1818 WOODDALE DR STE 201
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City | WOODBURY
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State | MN
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Zip | 55125-2983
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Country | US
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Telephone | 651-440-6669
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Fax |
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Provider Business Mailing Address
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Address Line | 6043 HUDSON RD STE 140P
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City | WOODBURY
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State | MN
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Zip | 55125-1030
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Country | US
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Telephone | 651-373-3886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TRACI ASTRID VALENTINE
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Credential | M.ED., LMFT
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Telephone | 651-373-3886
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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 | 2187
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License Number State | MN
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