Provider Demographics
NPI:1982841748
Name:FULL CIRCLE THERAPY
Entity Type:Organization
Organization Name:FULL CIRCLE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOMPART
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:952-892-8404
Mailing Address - Street 1:1500 MCANDREWS RD W
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4432
Mailing Address - Country:US
Mailing Address - Phone:952-892-8404
Mailing Address - Fax:952-892-1722
Practice Address - Street 1:1500 MCANDREWS RD W
Practice Address - Street 2:SUITE 230
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4432
Practice Address - Country:US
Practice Address - Phone:952-892-8404
Practice Address - Fax:952-892-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN99G54FUOtherBLUE CROSS BLUE SHIELD
MN513690300Medicaid