Provider Demographics
NPI:1891988234
Name:TANNUZZO, MOLLY (LMFT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:TANNUZZO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 FLORIDA AVE S STE 307
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1759
Mailing Address - Country:US
Mailing Address - Phone:952-544-6806
Mailing Address - Fax:952-545-0098
Practice Address - Street 1:715 FLORIDA AVE S STE 307
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1759
Practice Address - Country:US
Practice Address - Phone:952-544-6806
Practice Address - Fax:952-545-0098
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist