Provider Demographics
NPI:1366837437
Name:TYREE-DAHLBERG, STEPHANIE MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:TYREE-DAHLBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:TYREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAMFT
Mailing Address - Street 1:PO BOX 1309 - 8170 33RD AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-4793
Mailing Address - Fax:651-254-0877
Practice Address - Street 1:2345 ARIEL STREET NORTH
Practice Address - Street 2:MAIL STOP 13601A
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2248
Practice Address - Country:US
Practice Address - Phone:651-254-4793
Practice Address - Fax:651-254-0877
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2638106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist