Provider Demographics
NPI:1124471107
Name:TURNING LEAF THERAPY
Entity type:Organization
Organization Name:TURNING LEAF THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:651-330-6205
Mailing Address - Street 1:2589 HAMLINE AVE N STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3185
Mailing Address - Country:US
Mailing Address - Phone:651-330-6205
Mailing Address - Fax:651-330-8718
Practice Address - Street 1:2589 HAMLINE AVE N STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3185
Practice Address - Country:US
Practice Address - Phone:651-330-6205
Practice Address - Fax:651-330-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2425251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health