Organization
PENTICOFF COMMUNITY COUNSELING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENEE MARIE PENTICOFF PSY.D. (OWNER, PRESIDENT)
(651) 255-6678
Entity
Organization
Contact information
Practice address
1818 WOODDALE DR STE 204, WOODBURY, MN 55125-2983
(651) 255-6678
(651) 501-6091
Mailing address
PO BOX 25334, WOODBURY, MN 55125-0334
(651) 255-6678
(651) 501-6091
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP-4060
MN
Other
Enumeration date
08/12/2009
Last updated
08/12/2009
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