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General NPI Number Information
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NPI Number | 1659761633
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Entity Type | Organization
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Legal Business Name | MINNESOTA COUNSELING AND THERAPY CENTER, INC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 5221 VIKING DR STE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5323
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Country | US
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Telephone | 612-849-4792
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Fax | 612-677-3722
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Provider Business Mailing Address
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Address Line | 5221 VIKING DR STE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5323
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Country | US
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Telephone | 612-849-4792
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Fax | 612-677-3722
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ERIN ELIZABETH SHOBE
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Credential | M.A., LMFT
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Telephone | 612-849-4792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1560
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License Number State | MN
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