Profound Therapy LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

PROFOUND THERAPY LLC

Practice address

720 8TH Ave N
Saint Cloud, MN 56303-3420

Phone

(320) 266-1693

Fax

(320) 251-0217

NPI assigned

Jul 7, 2012

Organization subpart

No

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

Authorized official

Name

Nicole J Otis, LMFT

Title

Owner - Marriage & Family Therapist

Phone

(320) 266-1693

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1341619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389571200000",
    "number": "1386909281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 8TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033420",
            "telephone_number": "320-266-1693",
            "fax_number": "320-251-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 8TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033420",
            "telephone_number": "320-266-1693",
            "fax_number": "320-251-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFOUND THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-07",
        "last_updated": "2014-01-13",
        "status": "A",
        "authorized_official_last_name": "OTIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER - MARRIAGE & FAMILY THERAPIST",
        "authorized_official_telephone_number": "320-266-1693",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.