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General NPI Number Information
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NPI Number | 1831545771
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Entity Type | Organization
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Legal Business Name | COUNSELING AND THERAPEUTIC SUPPORT SERVICES PLLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 600 W 78TH ST STE 10I
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City | CHANHASSEN
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State | MN
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Zip | 55317-2601
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Country | US
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Telephone | 612-702-1976
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | CHANHASSEN
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State | MN
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Zip | 55317-0477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/CFO
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Name | MRS. KATHRYN MARIE-WILKER BARRETT
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Credential | MA, LMFT
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Telephone | 612-702-1976
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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 | 2272
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License Number State | MN
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