Organization
ENRICHMENT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACI EMMICK MA LMFT (OWNER/OPERATOR)
(651) 442-1901
Entity
Organization
Contact information
Practice address
2115 KIMBALL AVE NW, ANNANDALE, MN 55302-3229
(651) 301-8023
(612) 446-5778
Mailing address
PO BOX 132, FARMINGTON, MN 55024-0132
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195283841
—
MN
01
—
3487
MARRIAGE AND FAMILY THERAPY LICENSE
MN
Enumeration date
10/19/2023
Last updated
10/19/2023
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