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General NPI Number Information
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NPI Number | 1760886840
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Entity Type | Organization
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Legal Business Name | TALK THERAPY
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 11800 SINGLETREE LN SUITE 204
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5328
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Country | US
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Telephone | 612-965-3052
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Fax |
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Provider Business Mailing Address
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Address Line | 11800 SINGLETREE LN SUITE 204
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5328
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Country | US
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Telephone | 612-965-3052
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | CINDY LEA
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Credential | MA
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Telephone | 612-965-3052
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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 | 2465
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License Number State | MN
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