=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821456757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING LIVING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2016
-----------------------------------------------------
Last Update Date | 12/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 RAYMOND AVE STE 105
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55114-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-405-7057
-----------------------------------------------------
Fax | 612-729-0146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3332 LONGFELLOW AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55407-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-702-3052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RACHEL PASTERNAK SLATER
-----------------------------------------------------
Credential | PH.D., L.P.
-----------------------------------------------------
Telephone | 612-405-7057
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LP 5141
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------