Provider Demographics
NPI:1700558277
Name:GILLER RATHE, ABBEY PAULINE (LPCC)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:PAULINE
Last Name:GILLER RATHE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17661 69TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3027
Mailing Address - Country:US
Mailing Address - Phone:402-630-6124
Mailing Address - Fax:
Practice Address - Street 1:3340 REPUBLIC AVE STE 110
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4189
Practice Address - Country:US
Practice Address - Phone:952-209-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3028101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health