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General NPI Number Information
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NPI Number | 1780094904
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Entity Type | Organization
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Legal Business Name | COMMUNITY TREE COUNSELING
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 1500 MCANDREWS RD W STE 222
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City | BURNSVILLE
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State | MN
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Zip | 55337-4445
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Country | US
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Telephone | 612-554-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 13408 ALDRICH AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55337-4388
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Country | US
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Telephone | 612-554-6069
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MARISSA MARIE MITCHELL
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Credential |
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Telephone | 612-554-6069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1709
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License Number State | MN
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