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General NPI Number Information
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NPI Number | 1538483946
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Entity Type | Organization
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Legal Business Name | QUEST SEXUALITY SPECIFIC SERVICES
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 25 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-1103
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Country | US
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Telephone | 651-266-5213
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Fax |
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Provider Business Mailing Address
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Address Line | 25 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-1103
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Country | US
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Telephone | 651-266-5213
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | RYAN JOHN SORENSEN
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Credential | M.A.
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Telephone | 612-703-5275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC00676
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License Number State | MN
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