Provider Demographics
NPI:1154091502
Name:THESTRAL THERAPY, LLC
Entity Type:Organization
Organization Name:THESTRAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-500-1377
Mailing Address - Street 1:7421 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4118
Mailing Address - Country:US
Mailing Address - Phone:651-500-1377
Mailing Address - Fax:
Practice Address - Street 1:7421 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-4118
Practice Address - Country:US
Practice Address - Phone:651-500-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)