Intentional Self Counseling, Coaching, and Consultation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1939 Issued in MN

Legal business name

INTENTIONAL SELF COUNSELING, COACHING, AND CONSULTATION

Practice address

1154 Grand Ave Ste 2
Saint Paul, MN 55105-2628

Phone

(763) 228-4752

NPI assigned

May 5, 2014

Organization subpart

No

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

Authorized official

Name

Tara Lemke Ebenhoch, LMFT

Title

Owner

Phone

(763) 228-4752

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399248000000",
    "number": "1760892244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2547 DAHL AVE E",
            "address_2": "MAPLEWOOD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551196500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1154 GRAND AVE STE 2",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052628",
            "telephone_number": "763-228-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL SELF COUNSELING, COACHING, AND CONSULTATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-05",
        "last_updated": "2014-05-05",
        "status": "A",
        "authorized_official_last_name": "LEMKE EBENHOCH",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-228-4752",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "1939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.