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General NPI Number Information
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NPI Number | 1639343783
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Entity Type | Organization
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Legal Business Name | MN MENTAL HEALTH CONSULTING LLC
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Dates
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Enumeration Date | 04/19/2008
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 7600 PARKLAWN AVE #380
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 612-203-2961
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Fax | 952-831-0033
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Provider Business Mailing Address
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Address Line | 7600 PARKLAWN AVE #380
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City | EDINA
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State | MN
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Zip | 55435-5125
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Country | US
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Telephone | 612-203-2961
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Fax | 952-831-0033
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Authorized Official
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Title or Position | THERAPIST
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Name | MICHELLE C PETERSON
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Credential | LMFT
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Telephone | 612-203-2961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1315
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License Number State | MN
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