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General NPI Number Information
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NPI Number | 1982841748
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE THERAPY
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 1500 MCANDREWS RD W SUITE 230
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 952-892-8404
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Fax | 952-892-1722
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Provider Business Mailing Address
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Address Line | 1500 MCANDREWS RD W SUITE 230
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 952-892-8404
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Fax | 952-892-1722
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | JOAN S LOMPART
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Credential | MA, LMFT
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Telephone | 952-892-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1140
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License Number State | MN
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