MEDICARE: THOOFT CONSULTING

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	:	1881410330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOOFT CONSULTING

Provider Business Mailing Address
First Line	:	16573 ELM CREEK CT
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-3421
Country	:	US
Telephone Number	:	651-398-9262
Fax Number	:

Provider Business Practice Location Address
First Line	:	16573 ELM CREEK CT
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-3421
Country	:	US
Telephone Number	:	651-398-9262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA ROSE THOOFT
Credential	:	MSW, LICSW
Telephone Number	:	651-398-9262

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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