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General NPI Number Information
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NPI Number | 1861871709
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Entity Type | Organization
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Legal Business Name | DOORWAY COUNSELING
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 14041 BURNHAVEN DR STE 145
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City | BURNSVILLE
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State | MN
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Zip | 55337-4408
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Country | US
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Telephone | 612-876-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 LONGFELLOW AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3635
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Country | US
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Telephone | 612-876-2700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY HEAGLE WARD
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Credential |
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Telephone | 612-876-2700
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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 | 2548
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License Number State | MN
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