Provider Demographics
NPI:1497880108
Name:ERVIN COUNSELING & FAMILY LIFE MINISTRIES, P.A.
Entity Type:Organization
Organization Name:ERVIN COUNSELING & FAMILY LIFE MINISTRIES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:952-345-4510
Mailing Address - Street 1:7200 FRANCE AVE S
Mailing Address - Street 2:SUITE 338
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4300
Mailing Address - Country:US
Mailing Address - Phone:952-345-4510
Mailing Address - Fax:952-835-5679
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 338
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-345-4510
Practice Address - Fax:952-835-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180P7EROtherBCBSM GROUP PROVIDER #