Organization
BRAVE SOUL COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILL M. ELLINGSON MA, LMFT (OWNER & CLINICAL DIRECTOR)
(612) 242-1224
Entity
Organization
Contact information
Practice address
445 BROADWAY AVE STE A, ST PAUL PARK, MN 55071-1554
(612) 242-1224
(651) 340-2587
Mailing address
445 BROADWAY AVE STE A, ST PAUL PARK, MN 55071-1554
(612) 242-1224
(651) 340-2587
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2671
MN
Other
Enumeration date
11/02/2015
Last updated
02/10/2020
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