Provider Demographics
NPI:1104458876
Name:SEVERSON, ZOEY C X (LPC)
Entity type:Individual
Prefix:MRS
First Name:ZOEY
Middle Name:C
Last Name:SEVERSON
Suffix:X
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELARD PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6453
Mailing Address - Country:US
Mailing Address - Phone:763-522-0100
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELARD PKWY
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55441-6411
Practice Address - Country:US
Practice Address - Phone:763-522-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN02355OtherBOARD OF BEHAVIORAL HEALTH AND THERAPY
MNL055729-4OtherMINNESOTA BOARD OF NURSING