Provider Demographics
NPI:1679357826
Name:CATS CANDOR THERAPY PA
Entity Type:Organization
Organization Name:CATS CANDOR THERAPY PA
Other - Org Name:CATS AND CANDOR THERAPY PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-445-9801
Mailing Address - Street 1:7808 NOID DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10650 COUNTY ROAD 81 STE 133
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4020
Practice Address - Country:US
Practice Address - Phone:763-445-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty