Provider Demographics
NPI:1922474188
Name:TWIN CITIES PSYCHOLOGY & COUPLES CENTER
Entity Type:Organization
Organization Name:TWIN CITIES PSYCHOLOGY & COUPLES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:ZAJAC
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-249-9450
Mailing Address - Street 1:2353 RICE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3739
Mailing Address - Country:US
Mailing Address - Phone:651-249-9450
Mailing Address - Fax:
Practice Address - Street 1:4273 ROSEMARY CT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-3047
Practice Address - Country:US
Practice Address - Phone:651-249-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty