MEDICARE: SAMMEN PSYCHOTHERAPY

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	1551	MN

General Provider Information

NPI Number	:	1992171383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMMEN PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	970 RAYMOND AVE
Second Line	:	SUITE 200
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 RAYMOND AVE
Second Line	:	SUITE 200
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1146
Country	:	US
Telephone Number	:	651-233-7665
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	SONJA KROMROY
Credential	:
Telephone Number	:	651-233-7665

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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