Provider Demographics
NPI:1013632553
Name:SELLBERG, COURTNEY RUTH (LPCC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RUTH
Last Name:SELLBERG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RUTH
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:262 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-4819
Mailing Address - Country:US
Mailing Address - Phone:651-319-1776
Mailing Address - Fax:
Practice Address - Street 1:262 POPLAR DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-4819
Practice Address - Country:US
Practice Address - Phone:651-319-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional