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General NPI Number Information
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NPI Number | 1831576453
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Entity Type | Organization
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Legal Business Name | CENTER FOR WOMEN'S GROUP THERAPY
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 11900 WAYZATA BLVD STE 200
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City | MINNETONKA
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State | MN
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Zip | 55305-2031
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Country | US
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Telephone | 612-701-0066
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Fax | 952-546-1308
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Provider Business Mailing Address
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Address Line | 3754 PLEASANT AVE STE 205
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1279
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Country | US
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Telephone | 612-802-1405
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Fax |
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Authorized Official
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Title or Position | GEN PTR
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Name | ILISE KATZ
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Credential | LPCC
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Telephone | 612-701-0066
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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 | CC0021
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License Number State | MN
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