Provider Demographics
NPI:1720329980
Name:EAGLE, RINDIE (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:RINDIE
Middle Name:
Last Name:EAGLE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:RINDIE
Other - Middle Name:
Other - Last Name:COHOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18846 SMITH DR NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-7510
Mailing Address - Country:US
Mailing Address - Phone:763-370-5014
Mailing Address - Fax:
Practice Address - Street 1:21395 JOHN MILLESS DR STE 400
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4407
Practice Address - Country:US
Practice Address - Phone:763-424-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1167101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1167OtherBOARD OF BEHAVIORAL HEALTH AND THERAPY - LPCC