Provider Demographics
NPI:1124417878
Name:TAMERA MENSINK TM COUNSELING LLC
Entity Type:Organization
Organization Name:TAMERA MENSINK TM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MENSINK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-373-9440
Mailing Address - Street 1:7600 143RD ST W STE 300
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5529
Mailing Address - Country:US
Mailing Address - Phone:651-373-9440
Mailing Address - Fax:866-712-6334
Practice Address - Street 1:7600 143RD ST W STE 300
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5529
Practice Address - Country:US
Practice Address - Phone:651-373-9440
Practice Address - Fax:866-712-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1124417878OtherNPI 2 NUMBER
MN1144588591OtherINDIVIDUAL NPI NUMBER
MN1144588591OtherINDIVIDUAL NPI NUMBER