Provider Demographics
NPI:1558131417
Name:IMPRESSIONS THERAPY, PLLC
Entity Type:Organization
Organization Name:IMPRESSIONS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SUNCIRE-NERISON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-517-7615
Mailing Address - Street 1:1487 WOODHILL RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2266
Mailing Address - Country:US
Mailing Address - Phone:612-517-7615
Mailing Address - Fax:833-303-3738
Practice Address - Street 1:7400 LYNDALE AVE S STE 160
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4142
Practice Address - Country:US
Practice Address - Phone:612-517-7615
Practice Address - Fax:833-303-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)