Provider Demographics
NPI:1003915935
Name:STRESEMANN, MARCIE L (LPCC)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:L
Last Name:STRESEMANN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27775 112TH ST
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-9458
Mailing Address - Country:US
Mailing Address - Phone:763-856-4131
Mailing Address - Fax:
Practice Address - Street 1:7260 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 235
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3126
Practice Address - Country:US
Practice Address - Phone:763-572-2605
Practice Address - Fax:763-572-2606
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00027101YM0800X
MNLPC 103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP69922OtherHEALTH PARTNERS