Individual provider Active NPI

Marita K Glasgow, LMFT

  • Marriage & Family Therapist
  • New Hope, MN
National Provider Identifier
1043671191
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
4052 Issued in MN
Practice address
5555 Boone Ave N
New Hope, MN 55428-3636
Phone
(651) 774-0011
Fax
(651) 774-0606
NPI assigned
Mar 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 4052 MN Primary

Addresses

Primary practice location

5555 Boone Ave N
New Hope, MN 55428-3636

Mailing address

1619 Dayton Ave Ste 108
Saint Paul, MN 55104-6276
Phone (651) 888-1286

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241122003507 MN Practitioner - Marriage and Family Therapist 8325573611 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4052MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Spaces Therapy LLC CurrentSince Sep 1, 2024 Accepting new patients
People Incorporated Current Accepting new patients
People Incorporated CurrentSince Oct 21, 2024 Accepting new patients
Youable Emotional Health Services PastSince Jan 5, 2023 Accepting new patients
Family Innovations, Inc. Marriage & Family Therapist PastSince Aug 6, 2019 Accepting new patients
People Incorporated Past Accepting new patients

Locations

2120 Park Ave
Minneapolis, MN 55404
Phone (612) 872-2000

1930 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 427-7964

5555 Boone Ave N
New Hope, MN 55428
Phone (763) 331-3033

3000 Ames Crossing Rd
Ste 600
Saint Paul, MN 55121
Phone (651) 288-3467

317 York Ave
Saint Paul, MN 55130
Phone (651) 771-0286

1619 Dayton Ave
Ste 108
Saint Paul, MN 55104
Phone (651) 888-1286

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1043671191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 DAYTON AVE STE 108",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046276",
            "telephone_number": "651-888-1286",
            "fax_number": "651-391-2033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 BOONE AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283636",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASGOW",
        "first_name": "MARITA",
        "middle_name": "K",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-17",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hope, MN

Sources for this page

Verify at the official NPI Registry.