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1705 Southcross Dr W Unit 101 Burnsville MN 55306-7027 | |
(952) 225-1575 | |
Not Available |
Full Name | |
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Speciality | Marriage & Family Therapist |
Location | 1705 Southcross Dr W Unit 101, Burnsville, Minnesota |
Authorized Official Name and Position | Olga Lidia Tapia-farrell (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 6122695313 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 363 Farmington MN 55024-0363 Ph: (612) 269-5313 | 1705 Southcross Dr W Unit 101 Burnsville MN 55306-7027 Ph: (952) 225-1575 |
NPI Number | 1356752463 |
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Provider Enumeration Date | 05/12/2014 |
Last Update Date | 04/15/2024 |
Certification Date | 04/15/2024 |
Medicare PECOS PAC ID | 0143763870 |
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Medicare Enrollment ID | O20240621002242 |
Identifier | Type | State | Issuer |
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1356752463 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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106H00000X | Marriage & Family Therapist | 1024 (Minnesota) | Primary |
Provider Name | Olga Lidia Tapia-farrell |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1538426994 PECOS PAC ID: 1052854783 Enrollment ID: I20240621002421 |
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