Provider Demographics
NPI:1407617814
Name:ONE GOAT THERAPY
Entity Type:Organization
Organization Name:ONE GOAT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOMATIC PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:DRAKE
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, RSMT
Authorized Official - Phone:612-735-0061
Mailing Address - Street 1:2637 27TH AVE S STE 250
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1565
Mailing Address - Country:US
Mailing Address - Phone:651-301-8252
Mailing Address - Fax:
Practice Address - Street 1:2637 27TH AVE S STE 250
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1565
Practice Address - Country:US
Practice Address - Phone:612-735-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health