Provider Demographics
NPI:1689861494
Name:MINNESOTA COUNSELING AND THERAPY CENTER
Entity Type:Organization
Organization Name:MINNESOTA COUNSELING AND THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, RPT
Authorized Official - Phone:612-708-6491
Mailing Address - Street 1:140 W 98TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4865
Mailing Address - Country:US
Mailing Address - Phone:612-708-6491
Mailing Address - Fax:612-677-3722
Practice Address - Street 1:140 W 98TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4865
Practice Address - Country:US
Practice Address - Phone:612-708-6491
Practice Address - Fax:612-677-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1560251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health