Provider Demographics
NPI:1487863163
Name:ROTACH, DAN (D,MIN, LMFT)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:ROTACH
Suffix:
Gender:M
Credentials:D,MIN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-7055
Mailing Address - Country:US
Mailing Address - Phone:651-486-4828
Mailing Address - Fax:651-482-9119
Practice Address - Street 1:3499 LEXINGTON AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-7055
Practice Address - Country:US
Practice Address - Phone:651-486-4828
Practice Address - Fax:651-482-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist