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General NPI Number Information
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NPI Number | 1609237809
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Entity Type | Organization
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Legal Business Name | DOWN TO EARTH THERAPY LLC
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/09/2024
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Provider Practice Location Address
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Address Line | 1114 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2628
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Country | US
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Telephone | 651-352-7105
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Fax | 877-292-0677
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Provider Business Mailing Address
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Address Line | 1114 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2628
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Country | US
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Telephone | 612-735-9676
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Fax | 877-292-0677
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY ANNE EVANS
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Credential | LMFT
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Telephone | 651-352-7105
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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 | 1871
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License Number State | MN
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