Provider Demographics
NPI:1134588122
Name:STEVEN C SEVERSON PSYCHOTHERAPY, LLC.
Entity type:Organization
Organization Name:STEVEN C SEVERSON PSYCHOTHERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:952-683-1562
Mailing Address - Street 1:13245 FINDLAY AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8142
Mailing Address - Country:US
Mailing Address - Phone:952-683-1562
Mailing Address - Fax:
Practice Address - Street 1:8170 OLD CARRIAGE CT
Practice Address - Street 2:STE 241
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3163
Practice Address - Country:US
Practice Address - Phone:952-683-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health