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General NPI Number Information
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NPI Number | 1811717341
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Entity Type | Organization
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Legal Business Name | COURAGEOUS COUNSELING LLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 825 NICOLLET MALL STE 413
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2606
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Country | US
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Telephone | 612-279-8503
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Fax |
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Provider Business Mailing Address
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Address Line | 241 DAYTON AVE APT 1
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City | SAINT PAUL
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State | MN
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Zip | 55102-3398
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Country | US
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Telephone | 612-279-8503
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTIONER
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Name | KAITLYN VALDEZ
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Credential | MA, LPC
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Telephone | 612-279-8503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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