Provider Demographics
NPI:1457726721
Name:SERCK-HANSSEN, INGRID (LPCC)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:SERCK-HANSSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 ZEALAND AVE N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316
Mailing Address - Country:US
Mailing Address - Phone:612-293-7035
Mailing Address - Fax:
Practice Address - Street 1:11108 ZEALAND AVE N STE 106
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3594
Practice Address - Country:US
Practice Address - Phone:612-293-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health