Provider Demographics
NPI:1003555046
Name:TANGLEFISH EMOTIONAL HEALING LLC
Entity Type:Organization
Organization Name:TANGLEFISH EMOTIONAL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:612-213-4510
Mailing Address - Street 1:821 RAYMOND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1525
Mailing Address - Country:US
Mailing Address - Phone:612-213-4510
Mailing Address - Fax:612-361-5464
Practice Address - Street 1:821 RAYMOND AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1525
Practice Address - Country:US
Practice Address - Phone:612-213-4510
Practice Address - Fax:612-361-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-28
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1982258125OtherNPI 1