Individual
PORSCHE PEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT, LADC
Contact information
Practice address
2864 MIDDLE ST STE 100, LITTLE CANADA, MN 55117-1411
(651) 493-2055
(651) 340-8632
Mailing address
2864 MIDDLE ST STE 100, LITTLE CANADA, MN 55117-1411
(651) 493-2055
(651) 340-8632
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304885
MN
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
3415
MN
Other
Enumeration date
08/24/2016
Last updated
03/25/2019
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