Provider Demographics
NPI:1689421836
Name:CORHOUSE, TODD (LADC, LPCC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:CORHOUSE
Suffix:
Gender:M
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 E 18TH ST APT 231
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1914
Mailing Address - Country:US
Mailing Address - Phone:763-439-0598
Mailing Address - Fax:
Practice Address - Street 1:11334 86TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4528
Practice Address - Country:US
Practice Address - Phone:763-255-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health