Organization
LIFE ESSENTIALS PSYCHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THAO-HA PHAN MA, LMFT, LADC (MEMBER)
(763) 317-8255
Entity
Organization
Contact information
Practice address
13750 CROSSTOWN DR NW STE 10, ANDOVER, MN 55304-5853
(763) 317-8255
(855) 913-2522
Mailing address
13750 CROSSTOWN DR NW STE 10, ANDOVER, MN 55304-5853
(763) 317-8255
(855) 913-2522
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124572235
—
MN
Enumeration date
08/05/2016
Last updated
10/10/2025
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