Provider Demographics
NPI:1285395707
Name:FRUETEL, GLORINA SAUCEDO (LMFT)
Entity type:Individual
Prefix:MS
First Name:GLORINA
Middle Name:SAUCEDO
Last Name:FRUETEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 EDGEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3807
Mailing Address - Country:US
Mailing Address - Phone:651-269-6920
Mailing Address - Fax:
Practice Address - Street 1:241 CLEVELAND AVE S STE B5
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1255
Practice Address - Country:US
Practice Address - Phone:651-269-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist