Provider Demographics
NPI:1215796149
Name:SKEIDE, CASEY ORVIS (LMFT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:ORVIS
Last Name:SKEIDE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:KEI
Other - Middle Name:
Other - Last Name:SKEIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:730 E 38TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-5218
Mailing Address - Country:US
Mailing Address - Phone:612-208-2831
Mailing Address - Fax:888-778-2961
Practice Address - Street 1:5725 KNOX AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1559
Practice Address - Country:US
Practice Address - Phone:651-587-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist