Organization
DIVINE LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CARL TORKELSON LMFT (CEO)
(763) 200-4006
Entity
Organization
Contact information
Practice address
506 FREEPORT AVE NW, ELK RIVER, MN 55330-4611
(763) 200-4006
Mailing address
506 FREEPORT AVE NW, ELK RIVER, MN 55330-4611
(763) 200-4006
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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