Organization
AND THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY MAUREEN LANGE (OWNER)
(651) 343-5391
Entity
Organization
Contact information
Practice address
2400 SUNRISE DR, LITTLE CANADA, MN 55117-1661
(651) 343-5391
Mailing address
2400 SUNRISE DR, LITTLE CANADA, MN 55117-1661
(651) 343-5391
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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