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Organization
CENTERLIFE COUNSELING, LLC
Active
Organization
CENTERLIFE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ANN LUNDHOLM-EADES (OWNER)
(651) 288-0332
Entity
Organization
Contact information
Practice address
7039 20TH AVE, CENTERVILLE, MN 55038-9737
(651) 288-0332
Mailing address
7039 20TH AVE, CENTERVILLE, MN 55038-9737
(651) 288-0332
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
NULL
103TF0000X
Family Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
942
MN
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
Other
Enumeration date
10/18/2009
Last updated
01/21/2019
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