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General NPI Number Information
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NPI Number | 1568267151
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Entity Type | Organization
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Legal Business Name | HYPERINTELLIGENT STOAT LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 711 W LAKE ST STE 201
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-3357
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Country | US
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Telephone | 612-314-9542
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Fax |
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Provider Business Mailing Address
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Address Line | 4528 MADISON ST NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-2363
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEONG EUN PARK
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Credential | LMFT
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Telephone | 612-314-9542
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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 |
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License Number State |
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