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General NPI Number Information
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NPI Number | 1942630728
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Entity Type | Organization
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Legal Business Name | MULTICULTURAL PSYCHOTHERAPY AND CONSULTING SERVICES LTD
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 3133 HENNEPIN AVE SOUTH (LOWER LEVEL)
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2620
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Country | US
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Telephone | 612-702-3483
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Fax | 651-633-1219
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Provider Business Mailing Address
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Address Line | 4471 HIGHWAY 10
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City | ARDEN HILLS
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State | MN
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Zip | 55112-1952
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Country | US
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Telephone | 612-702-3483
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Fax | 651-633-1219
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Authorized Official
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Title or Position | OWNER
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Name | KATIA R LOPEZ-PETROVICH
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Credential | LMFT
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Telephone | 612-702-3483
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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 | 2238
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License Number State | MN
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