MEDICARE: EAGAN PSYCHOTHERAPY LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518501584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGAN PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	3464 WASHINGTON DR STE 115
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1453
Country	:	US
Telephone Number	:	651-348-8551
Fax Number	:

Provider Business Practice Location Address
First Line	:	3464 WASHINGTON DR STE 115
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1453
Country	:	US
Telephone Number	:	651-348-8551
Fax Number	:	651-409-2029

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MACKENZIE KERBER
Credential	:	LPCC
Telephone Number	:	651-348-8551

Provider Enumeration Date	:	11/03/2019
Last Update Date	:	09/12/2025

Similar Medicare Providers

1942138615 — MEGHAN KEATING MSW, LICSW
Practice Location Address:

3464 WASHINGTON DR
EAGAN, MN
55122-1453

Practice Phone: 651-348-8551
Practice Fax: 651-409-2029

1093119786 — AMANDA ENSTROM M.A., CCC-SLP
Practice Location Address:

3464 WASHINGTON DR , SUITE 110
EAGAN, MN
55122-1453

Practice Phone: 952-460-4278
Practice Fax:

1831541168 — MACKENZIE LEA KERBER LPCC
Practice Location Address:

3464 WASHINGTON DR STE 115
EAGAN, MN
55122-1453

Practice Phone: 651-348-8551
Practice Fax: 651-409-2029

1841725009 — SAMANTHA FRANKLIN
Practice Location Address:

3464 WASHINGTON DR STE 115
EAGAN, MN
55122-1453

Practice Phone: 651-348-8551
Practice Fax: 651-409-2029

1851220198 — DR. TAYLER RAE DINGMANN DDS
Practice Location Address:

1905 PLAZA DR
EAGAN, MN
55122-2883

Practice Phone: 651-686-6800
Practice Fax:

1518897487 — DAVID DELOSS JOHNSON DDS
Practice Location Address:

1905 PLAZA DR
EAGAN, MN
55122-2883

Practice Phone: 651-686-6800
Practice Fax:

Directions to “EAGAN PSYCHOTHERAPY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.