Provider Demographics
NPI:1558571273
Name:MINOR, BRUCE A (LMFT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:MINOR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 E 42ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3068
Mailing Address - Country:US
Mailing Address - Phone:612-501-9531
Mailing Address - Fax:
Practice Address - Street 1:2717 E 42ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3068
Practice Address - Country:US
Practice Address - Phone:612-501-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist