Provider Demographics
NPI:1770985806
Name:KOELMAN, RITA M X (LPCC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:KOELMAN
Suffix:X
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 1:4731 WASHBURN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3727
Mailing Address - Country:US
Mailing Address - Phone:218-689-4307
Mailing Address - Fax:
Practice Address - Street 1:7600 BOONE AVE N
Practice Address - Street 2:SUITE #2
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-4563
Practice Address - Country:US
Practice Address - Phone:763-515-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional