Organization
BRISTLECONE TO GO, INC.
Active
Other names
Bristlecone Health
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE GOMER LPC (CO-OWNER, COO)
(763) 913-4600
Entity
Organization
Contact information
Practice address
13700 REIMER DR N, SUITE 220, MAPLE GROVE, MN 55311-4580
(763) 424-2474
(763) 424-2711
Mailing address
13700 REIMER DR N, SUITE 220, MAPLE GROVE, MN 55311-4580
(763) 424-2474
(763) 424-2711
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
01664
MN
101Y00000X
Counselor
01666
MN
101YM0800X
Mental Health Counselor
01664
MN
101YM0800X
Mental Health Counselor
01666
MN
101YP2500X
Professional Counselor
01664
MN
101YP2500X
Professional Counselor
01666
MN
103K00000X
Behavior Analyst
01664
MN
103K00000X
Behavior Analyst
01666
MN
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
Primary
01664
MN
133NN1002X
Nutrition Education Nutritionist
01666
MN
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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