=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760063051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERTIN PSYCHOTHERAPY & CONSULTING SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2021
-----------------------------------------------------
Last Update Date | 04/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 W 78TH ST STE 450
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-412-4620
-----------------------------------------------------
Fax | 612-331-5662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8000 W 78TH ST STE 450
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-412-4620
-----------------------------------------------------
Fax | 612-331-5662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MEGAN VERTIN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 612-412-4620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------