Provider Demographics
NPI:1447963798
Name:PARK, JEONG EUN (LMFT)
Entity type:Individual
Prefix:
First Name:JEONG
Middle Name:EUN
Last Name:PARK
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:KIMBERIA
Other - Middle Name:JOY
Other - Last Name:SHERVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 E 38TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-5218
Mailing Address - Country:US
Mailing Address - Phone:612-208-3208
Mailing Address - Fax:
Practice Address - Street 1:730 E 38TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-5218
Practice Address - Country:US
Practice Address - Phone:612-208-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist