Mary Theresa Swenson, EDD
Individual provider Active NPI Mental Health Counselor · Ham Lake, MN
NPI 1093128233 · NPPES record last updated Dec 1, 2014
Key facts
- NPI
- 1093128233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 00808 (MN)
- Practice address
- 13750 Crosstown Dr Phase II
Suite 207
Ham Lake, MN 55304-2664 - Phone
- (763) 413-6971
- NPI assigned
- Jun 5, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00808 | MN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interpretive Leadership Inc | Mental Health | Past | Accepting new patients |
| Interpretive Leadership Incorporated | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 00808 | MN | Yes |
Addresses
Primary practice location
13750 Crosstown Dr Phase II
Suite 207
Ham Lake, MN 55304-2664
Mailing address
13750 Crosstown Dr NW
Molly Professional Center Phase II Suite 207
Andover, MN 55304
Phone (763) 755-6290
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01405 | Other | MN | STATE LICENSE |
Other names
- Mary Theresa Duren
Other providers in Ham Lake, MN
- Leyla Sanati-Zaker
- Karl Ritchie Schlotterbeck
- Kathrine Schmit
- Danielle Smith
- Hayley Lynn Stumne
- Diana Rose Symens
- Julie Anne Tarro
- Imaim Neng Thao
- Mitchell Timothy Thilges
- Kiaja Tolzmann
All providers in Ham Lake, MN · Mental Health Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2014. 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.