Provider Demographics
NPI:1760620991
Name:BRANDVOLD, REBEKAH SUSAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:SUSAN
Last Name:BRANDVOLD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HIGHWAY 169 N STE 220
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4058
Mailing Address - Country:US
Mailing Address - Phone:612-716-6795
Mailing Address - Fax:763-786-9729
Practice Address - Street 1:4900 HIGHWAY 169 N STE 220
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4058
Practice Address - Country:US
Practice Address - Phone:612-427-8197
Practice Address - Fax:763-762-6911
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist