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General NPI Number Information
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NPI Number | 1679357826
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Entity Type | Organization
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Legal Business Name | CATS CANDOR THERAPY PA
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 10650 COUNTY ROAD 81 STE 133
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4020
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Country | US
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Telephone | 763-445-9801
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Fax |
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Provider Business Mailing Address
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Address Line | 7808 NOID DR
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-2206
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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/MENTAL HEALTH PROFESSIONAL
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Name | CHRISTINE ISABEL PENA
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Credential | LMFT
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Telephone | 763-445-9801
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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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