Provider Demographics
NPI:1518501584
Name:EAGAN PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:EAGAN PSYCHOTHERAPY LLC
Other - Org Name:APRICITY COUNSELING AND WELLNESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KERBER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:651-348-8551
Mailing Address - Street 1:3464 WASHINGTON DR STE 115
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1453
Mailing Address - Country:US
Mailing Address - Phone:651-348-8551
Mailing Address - Fax:
Practice Address - Street 1:3464 WASHINGTON DR STE 115
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1453
Practice Address - Country:US
Practice Address - Phone:651-348-8551
Practice Address - Fax:651-409-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)