=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982984845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART OF THE CITY COUNSELING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2011
-----------------------------------------------------
Last Update Date | 06/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 SOUTHCROSS DR W 103
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55306-7916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-808-1400
-----------------------------------------------------
Fax | 952-808-1400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 760 SOUTHCROSS DR W SUITE 103
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55306-7916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 950-808-1400
-----------------------------------------------------
Fax | 952-808-1400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. KRISTIN JEAN AYDT
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 952-808-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1228
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------