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General NPI Number Information
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NPI Number | 1831875384
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Entity Type | Organization
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Legal Business Name | WEST METRO THERAPY, LLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 4025 W BROADWAY AVE
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2211
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Country | US
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Telephone | 612-239-5654
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Fax |
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Provider Business Mailing Address
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Address Line | 10671 106TH AVE N
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City | HANOVER
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State | MN
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Zip | 55341-4400
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Country | US
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Telephone | 612-239-5654
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE RAE RICHTER
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Credential | MA, LMFT
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Telephone | 612-239-5654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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