Provider Demographics
NPI:1588731400
Name:CONNOR, REBECCA (LMFT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:CONNOR
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 1:13030 12TH AVENUE NORTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:612-877-1081
Mailing Address - Fax:763-355-5354
Practice Address - Street 1:7415 WAYZATA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:612-877-1081
Practice Address - Fax:763-355-5344
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT 1036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
308J7COOtherBLUE CROSS BLUE SHIELD
6Z99506OtherMEDICH