Provider Demographics
NPI:1417699901
Name:GROETTUM, TARAH LYNN (MSED, LPCC)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:LYNN
Last Name:GROETTUM
Suffix:
Gender:F
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2720
Mailing Address - Country:US
Mailing Address - Phone:612-227-0971
Mailing Address - Fax:651-391-2072
Practice Address - Street 1:1581 LANCASTER LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2720
Practice Address - Country:US
Practice Address - Phone:612-227-0971
Practice Address - Fax:651-391-2072
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional