Provider Demographics
NPI:1396424446
Name:YOUR STORY MATTERS COUNSELING
Entity type:Organization
Organization Name:YOUR STORY MATTERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARTINA
Authorized Official - Last Name:RAPALO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-293-0635
Mailing Address - Street 1:1250 MOORE LAKE DR E STE 205D
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5176
Mailing Address - Country:US
Mailing Address - Phone:612-293-0635
Mailing Address - Fax:
Practice Address - Street 1:1250 MOORE LAKE DR E STE 205D
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5176
Practice Address - Country:US
Practice Address - Phone:612-293-0635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health