Provider Demographics
NPI:1558768895
Name:CARDINAL PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:CARDINAL PSYCHOTHERAPY, LLC
Other - Org Name:CARDINAL PSYCHOTHERAPY & COACHING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, LPCC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ALESCHA
Authorized Official - Last Name:SCHARLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-304-6047
Mailing Address - Street 1:7250 HUDSON BLVD N STE 205
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-7162
Mailing Address - Country:US
Mailing Address - Phone:651-447-3605
Mailing Address - Fax:651-634-1435
Practice Address - Street 1:7250 HUDSON BLVD N STE 205
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7162
Practice Address - Country:US
Practice Address - Phone:651-447-3605
Practice Address - Fax:651-634-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01220101YM0800X
MN1512101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty