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General NPI Number Information
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NPI Number | 1780175182
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Entity Type | Organization
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Legal Business Name | HIRAETH PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 4749 CHICAGO AVE STE 2B
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-4181
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Country | US
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Telephone | 612-404-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 4749 CHICAGO AVE STE 2B
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-4181
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Country | US
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Telephone | 612-404-0211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA MARIE FORD
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Credential | LPCC
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Telephone | 612-404-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1805
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License Number State | MN
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