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NPI Code Detail

MEDICARE: KRISTA MARIE JORGENSON MA, LPCC

MEDICARE: KRISTA MARIE JORGENSON MA, LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor1625MN

General Provider Information

NPI Number : 1114445210
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA MARIE JORGENSON MA, LPCC
Provider Business Mailing Address
First Line : 708 N 1ST ST STE 242
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-1145
Country : US
Telephone Number : 507-208-3504
Fax Number :
Provider Business Practice Location Address
First Line : 708 N 1ST ST STE 242
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-1145
Country : US
Telephone Number : 507-208-3504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2017
Last Update Date : 09/08/2017

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