Individual
MS. TERESA JOSEPHINE CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1874 3RD ST SW, NEW BRIGHTON, MN 55112
(763) 717-4979
(763) 717-4954
Mailing address
277 COON RAPIDS BLVD NW, SUITE 308, COON RAPIDS, MN 55433-5843
(763) 717-4979
(763) 717-4954
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LP2332
MN
103T00000X
Psychologist
LP2332
MN
103TA0400X
Addiction (Substance Use Disorder) Psychologist
LP2332
MN
103TB0200X
Cognitive & Behavioral Psychologist
LP2332
MN
103TC0700X
Clinical Psychologist
Primary
LP2332
MN
103TF0000X
Family Psychologist
LP2332
MN
103TP2701X
Group Psychotherapy Psychologist
LP2332
MN
106H00000X
Marriage & Family Therapist
LP2332
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57348CO
BLUECROSS PROVIDER NUMBER
MN
Enumeration date
11/12/2006
Last updated
08/01/2022
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