Individual
TRACI PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LPCC LADC
Contact information
Practice address
200 5TH ST NW STE E, ELK RIVER, MN 55330-5711
(763) 458-2967
(763) 260-5150
Mailing address
5560 145TH CIR NW, RAMSEY, MN 55303-5168
(763) 458-2967
(763) 260-5150
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303916
MN
101YM0800X
Mental Health Counselor
Primary
0311
MN
Other
Enumeration date
08/04/2014
Last updated
12/27/2023
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