Provider Demographics
NPI:1023627593
Name:ANGELA BRUST, LLC
Entity type:Organization
Organization Name:ANGELA BRUST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BRUST
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-987-8070
Mailing Address - Street 1:5960 NEWTON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-2017
Mailing Address - Country:US
Mailing Address - Phone:612-987-8070
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD STE 307
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1344
Practice Address - Country:US
Practice Address - Phone:612-987-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty