Organization
GILDERSLEEVE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI B GILDERSLEEVE MS,LP (OWNER)
(612) 386-3365
Entity
Organization
Contact information
Practice address
801 TWELVE OAKS CENTER DR, 803B, WAYZATA, MN 55391-4601
(952) 303-5487
Mailing address
801 TWELVE OAKS CENTER DR, 803B, WAYZATA, MN 55391-4601
(952) 303-5487
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP3779
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
934215000
—
MN
Enumeration date
12/05/2012
Last updated
12/05/2012
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