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General NPI Number Information
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NPI Number | 1598436198
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Entity Type | Organization
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Legal Business Name | EXPANDING CIRCLES, INC
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 1000 COUNTY ROAD E W STE 142
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City | SHOREVIEW
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State | MN
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Zip | 55126-8027
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Country | US
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Telephone | 612-254-5963
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Fax |
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Provider Business Mailing Address
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Address Line | 3790 VAN DYKE ST
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4740
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Country | US
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Telephone | 612-254-5963
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIRIAM CORNELL
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Credential | MA LMFT
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Telephone | 612-254-5963
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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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