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NPI Code Detail

MEDICARE: LEAH WELLSTONE MA. LMFT

MEDICARE: LEAH WELLSTONE MA. LMFT
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
1106H00000XMarriage & Family Therapist1187MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962401380
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH WELLSTONE MA. LMFT
Provider Business Mailing Address
First Line : 8640 EAGLE CREEK CIR
Second Line :
City : SAVAGE
State : MN
Zip : 55378-4400
Country : US
Telephone Number : 952-994-6896
Fax Number :
Provider Business Practice Location Address
First Line : 8640 EAGLE CREEK CIR
Second Line :
City : SAVAGE
State : MN
Zip : 55378-4400
Country : US
Telephone Number : 952-994-6896
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 11/04/2020

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Directions to “ LEAH WELLSTONE MA. LMFT” Practice Location

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