Provider Demographics
NPI:1790833853
Name:GROVES, CHARLOTTE LOUISE (LMFT)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:LOUISE
Last Name:GROVES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 FELTL CT APT 347
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3905
Mailing Address - Country:US
Mailing Address - Phone:920-290-0107
Mailing Address - Fax:
Practice Address - Street 1:1030 FELTL CT APT 347
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3905
Practice Address - Country:US
Practice Address - Phone:192-029-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI652-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI409-33800Medicaid