Judith Louise Ross Agustin, M.S., LMFT
Individual provider Active NPI Marriage & Family Therapist · Bloomington, MN
NPI 1003195082 · NPPES record last updated Jun 10, 2019
Key facts
- NPI
- 1003195082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 2534 (MN)
- Practice address
- 8100 Penn Ave S Ste 150H
Bloomington, MN 55431-1346 - Phone
- (612) 314-6012
- NPI assigned
- Aug 9, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT2659 | FL | MD | Marriage & Family Therapist |
| 2534 | MN | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MT2659 | FL | |
| Marriage & Family Therapist | 106H00000X | 2534 | MN | Yes |
Addresses
Primary practice location
8100 Penn Ave S Ste 150H
Bloomington, MN 55431-1346
Mailing address
8100 Penn Ave S Ste 150H
Bloomington, MN 55431-1346
Phone (612) 314-6012
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528451028 | Other | GROUP/BUSINESS ENTITY |
Other providers in Bloomington, MN
- Misbil Afrah
- Idil Agane
- Olawunmi Ramat Agboola Adekoya
- Marissa Jade Agerter
- Mark Courtland Agre
- Ayan Ahamed
- Aneesha Ahluwalia
- Ilham Ahmad
- Noman Ahmad
- Abdi Ahmed
All providers in Bloomington, MN · Marriage & Family Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.