Provider Demographics
NPI:1538694120
Name:BILSE, MEREDITH (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BILSE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 CAMDEN AVE N
Mailing Address - Street 2:APT 203
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1950
Mailing Address - Country:US
Mailing Address - Phone:612-716-0487
Mailing Address - Fax:
Practice Address - Street 1:5301 E RIVER RD
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-1024
Practice Address - Country:US
Practice Address - Phone:763-432-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist