Basic Information
| Provider Information | |||||||||
| NPI: | 1629624846 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPEACE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 JEFFERSON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551024740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518001225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 905 JEFFERSON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551024740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518001225 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2019 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOOPER | ||||||||
| AuthorizedOfficialFirstName: | LAREESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3164613133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT, LADC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.