MEDICARE: MARIPOSA CONSULTING AND THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CC00972	MN

General Provider Information

NPI Number	:	1093249138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIPOSA CONSULTING AND THERAPY

Provider Business Mailing Address
First Line	:	4405 PLEASANT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-4937
Country	:	US
Telephone Number	:	612-615-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 W LAKE ST STE 207
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2653
Country	:	US
Telephone Number	:	612-615-2700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMIE LARSON JONES
Credential	:	MS, LPCC
Telephone Number	:	612-615-2700

Provider Enumeration Date	:	04/15/2017
Last Update Date	:	04/15/2017

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