Organization
INTENTIONAL SELF COUNSELING, COACHING, AND CONSULTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA LEMKE EBENHOCH LMFT (OWNER)
(763) 228-4752
Entity
Organization
Contact information
Practice address
1154 GRAND AVE STE 2, SAINT PAUL, MN 55105-2628
(763) 228-4752
Mailing address
2547 DAHL AVE E, MAPLEWOOD, SAINT PAUL, MN 55119-6500
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1939
MN
Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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