Provider Demographics
NPI:1487617536
Name:DUMMER, CONSTANCE MARIE (LP, LMFT, RPT-S)
Entity type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:DUMMER
Suffix:
Gender:F
Credentials:LP, LMFT, RPT-S
Other - Prefix:
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Mailing Address - Street 1:6120 EARLE BROWN DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2123
Mailing Address - Country:US
Mailing Address - Phone:763-566-0088
Mailing Address - Fax:763-566-0089
Practice Address - Street 1:6120 EARLE BROWN DR
Practice Address - Street 2:SUITE #200
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2123
Practice Address - Country:US
Practice Address - Phone:763-566-0088
Practice Address - Fax:763-566-0089
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3364103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP3364OtherSTATE LICENSE #