Provider Demographics
NPI:1073985610
Name:TC THERAPY LLC
Entity Type:Organization
Organization Name:TC THERAPY LLC
Other - Org Name:TURNING LEAF THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:612-799-8258
Mailing Address - Street 1:2233 HAMLINE AVE N STE 411
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5006
Mailing Address - Country:US
Mailing Address - Phone:612-799-8258
Mailing Address - Fax:651-330-8718
Practice Address - Street 1:2233 HAMLINE AVE N STE 411
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5006
Practice Address - Country:US
Practice Address - Phone:612-799-8258
Practice Address - Fax:651-330-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2425261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2425OtherLICENSE
MN1801199302OtherNPI