ECLECTIC DRAGONFLY THERAPY SERVICES, PLLC (NPI# 1598120123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598120123 |
| Entity Type | Organization |
| Organization Name | ECLECTIC DRAGONFLY THERAPY SERVICES, PLLC |
| Other Organization Name | ECLECTIC DRAGONFLY THERAPY SERVICES |
| Practice Address |
108 6th Ave S Princeton MN 55371-1820 |
| Mailing Address |
Po Box 213 Princeton MN 55371-0213 |
| Practice Telephone | 7634821185 |
| Mailing Telephone | 7634821185 |
| Enumeration Date | 2015-12-26 |
| Last Update Date | 2015-12-26 |
| Authorized Official Name | JACQUELINE KELLY-FADDLER (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Telephone | 7634821185 |
| Authorized Official Credential | LPCC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
00842 | MN | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Eclectic Dragonfly Therapy Services | Doing Business As Name - Organization |
| Street Address |
108 6TH AVE S |
| City | PRINCETON |
| State | MN |
| Zip Code | 55371-1820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053962530 | Monica Gail Broten | Technician | 30840 Tiger Street Nw, Princeton, MN 55371 | 2019-09-25 |
| 1215349584 | Stephen Destefano | Pharmacist | 31419 131st Street, Princeton, MN 55371 | 2014-05-21 |
| 1164798948 | Andrew Sudbeck | Counselor | 101 18th Avenue North, Princeton, MN 55371 | 2012-03-27 |
| 1073804803 | Sterling Pointe Senior Living LLC | Assisted Living Facility | 1250 Northland Drive, Princeton, MN 55371 | 2011-04-27 |
| 1568752533 | Rum River Health Services, Inc. | Substance Abuse Rehabilitation Facility | 3079 90th Avenue, Princeton, MN 55371 | 2011-04-12 |
| 1780989038 | Dr. Kynan Westermeyer, Dds, Pllc | Clinic/Center | 404 1st St. N, Princeton, MN 55371 | 2011-01-18 |
| 1275788085 | Cody James Leff | Pharmacist | 1100 11th Avenue South, Princeton, MN 55371 | 2008-11-20 |
| 1164679213 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1101 N 5th St, Princeton, MN 55371 | 2008-08-20 |
| 1801059639 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1506 1st Street, Princeton, MN 55371 | 2008-07-02 |
| 1497940928 | James Michael Mandt | Pharmacist | 911 Northland Drive, Fairview Northland Medical Center, Princeton, MN 55371 | 2007-09-07 |
| Find all providers in zip 55371 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922624840 | Cherie M. Barton | Counselor | 6415 Fm 546 Lot 2, Princeton, TX 75407-4097 | 2020-06-17 |
| 1215577515 | Contee Botchford Moschberger | Counselor | 353 Nassau St, Princeton, NJ 08540-4623 | 2020-01-14 |
| 1841787900 | Magdalena Furniss | Counselor | 20 Nassau St Ste 226, Princeton, NJ 08542-4505 | 2018-04-15 |
| 1417451725 | Poonam D Patel | Counselor | 14 Farber Rd Ste 112, Princeton, NJ 08540-5913 | 2018-03-21 |
| 1679090344 | Sudha Nagarajan | Counselor | 145 Witherspoon St., Suite A7, Princeton, NJ 08540 | 2017-08-24 |
| 1437695756 | Kimberly Beury | Counselor | 29 Leigh Ave, Princeton, NJ 08542-3111 | 2017-01-10 |
| 1619344504 | Danice C. Banda | Counselor | 4499 Route 27 Ste 1, Princeton, NJ 08540-8717 | 2015-08-26 |
| 1477939460 | Kathy Diane Wyrick | Counselor | 220 South Walker Street, Princeton, WV 24740 | 2015-08-03 |
| 1083043798 | Esther Mills | Counselor | 218 Birch Ave, Princeton, NJ 08542-3106 | 2013-11-03 |
| 1548698558 | Shelley Gorenz | Counselor | 1009 S. Main St., Princeton, IL 61356 | 2013-10-30 |
| Find all providers in PRINCETON | ||||
Please comment or provide details below to improve the information on ECLECTIC DRAGONFLY THERAPY SERVICES, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.