Provider Demographics
NPI:1780207829
Name:AMAZING YOU THERAPY, LLC
Entity Type:Organization
Organization Name:AMAZING YOU THERAPY, LLC
Other - Org Name:AMAZING YOU THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-722-1139
Mailing Address - Street 1:421 1ST AVE SW STE 300W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3389
Mailing Address - Country:US
Mailing Address - Phone:507-722-1139
Mailing Address - Fax:888-682-9905
Practice Address - Street 1:421 1ST AVE SW STE 300W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3389
Practice Address - Country:US
Practice Address - Phone:507-722-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-23
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health