Organization
EAST METRO TRAUMA AND RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA LYNN GRABER LMFT (OWNER/CEO)
(612) 590-4440
Entity
Organization
Contact information
Practice address
4116 HOFFMAN RD, WHITE BEAR LAKE, MN 55110-3708
(612) 590-4440
(651) 494-5915
Mailing address
8154 ENCLAVE RD, WOODBURY, MN 55125-3032
(612) 590-4440
(651) 494-5915
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2672
BOARD OF MARRIAGE AND FAMILY THERAPY LICENSING BOARD
MN
Enumeration date
10/28/2020
Last updated
07/21/2022
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