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General NPI Number Information
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NPI Number | 1801226378
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Entity Type | Organization
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Legal Business Name | THOMAS RELATIONAL THERAPY, LLC
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 2233 HAMLINE AVE N SUITE 520
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City | ROSEVILLE
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State | MN
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Zip | 55113-5009
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Country | US
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Telephone | 612-868-6650
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Fax | 888-972-3921
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Provider Business Mailing Address
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Address Line | 2233 HAMLINE AVE N SUITE 520
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City | ROSEVILLE
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State | MN
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Zip | 55113-5009
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Country | US
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Telephone | 612-868-6650
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Fax | 888-972-3921
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Authorized Official
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Title or Position | THERAPIST
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Name | MICHAEL THOMAS
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Credential | LAMFT
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Telephone | 612-868-6650
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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 | 1921
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License Number State | MN
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