Provider Demographics
NPI:1447068697
Name:THERAPIST COOPERATIVE PRACTICE PLLC
Entity type:Organization
Organization Name:THERAPIST COOPERATIVE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-554-4843
Mailing Address - Street 1:3301 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1802
Mailing Address - Country:US
Mailing Address - Phone:612-554-4843
Mailing Address - Fax:
Practice Address - Street 1:1420 LONDON RD STE 204
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2422
Practice Address - Country:US
Practice Address - Phone:612-554-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty