MEDICARE: NANCY PRESCOTT 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
1	101YM0800X	Mental Health Counselor	1685	MN

General Provider Information

NPI Number	:	1134620487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY PRESCOTT LPCC

Provider Business Mailing Address
First Line	:	5000 W 36TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2758
Country	:	US
Telephone Number	:	651-269-4937
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 W 36TH ST # 207
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2758
Country	:	US
Telephone Number	:	651-269-4937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	08/19/2019

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