Provider Demographics
NPI:1144588591
Name:MENSINK, TAMERA RAE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:RAE
Last Name:MENSINK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MRS
Other - First Name:TAMERA
Other - Middle Name:RAE
Other - Last Name:FLATTUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:13839 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3760
Mailing Address - Country:US
Mailing Address - Phone:651-373-9440
Mailing Address - Fax:866-712-6334
Practice Address - Street 1:7600 143RD ST W
Practice Address - Street 2:SUITE 300
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5528
Practice Address - Country:US
Practice Address - Phone:651-373-9440
Practice Address - Fax:866-712-6337
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124417878OtherNPI 2 NUMBER
1124417878OtherNPI 2 NUMBER