MEDICARE: THERAPY GLOW MENTAL HEALTH & CONSULTING, PLLC

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	1041C0700X	Clinical Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1306584354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY GLOW MENTAL HEALTH & CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	658 E 143RD ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4609
Country	:	US
Telephone Number	:	612-386-3588
Fax Number	:

Provider Business Practice Location Address
First Line	:	658 E 143RD ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4609
Country	:	US
Telephone Number	:	612-386-3588
Fax Number	:

Authorized Official
Title or Position	:	CEO / OUTPATIENT PSYCHOTHERAPIST
Name	:	MS. VENUS L BURNEY
Credential	:	MSW, LICSW
Telephone Number	:	612-386-3588

Provider Enumeration Date	:	05/20/2022
Last Update Date	:	01/25/2026

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