Provider Demographics
NPI:1275668683
Name:SANTELLA, DAVID ALAN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:SANTELLA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2912
Mailing Address - Country:US
Mailing Address - Phone:952-232-6900
Mailing Address - Fax:952-960-0137
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2912
Practice Address - Country:US
Practice Address - Phone:952-232-6900
Practice Address - Fax:952-960-0137
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN874624200Medicaid