Individual
SAMUEL SECORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11990 PORTLAND AVE, BURNSVILLE, MN 55337-1516
(763) 310-6882
Mailing address
11990 PORTLAND AVE, BURNSVILLE, MN 55337-1516
(763) 310-6882
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
4474
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/27/2020
Last updated
08/06/2025
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