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General NPI Number Information
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NPI Number | 1689040222
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Entity Type | Organization
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Legal Business Name | NURTURE COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 4444 W 76TH ST SUITE 400
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City | EDINA
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State | MN
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Zip | 55435-5173
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Country | US
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Telephone | 612-564-8476
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 W 76TH ST SUITE 400
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City | EDINA
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State | MN
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Zip | 55435-5173
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Country | US
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Telephone | 612-564-8476
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA HEINO
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Credential |
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Telephone | 612-564-8476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17601
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License Number State | MN
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