MEDICARE: MR. ISAAC ROY HATCH-GILLETTE 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	101YP2500X	Professional Counselor	4726	MN

General Provider Information

NPI Number	:	1770256505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISAAC ROY HATCH-GILLETTE LPCC

Provider Business Mailing Address
First Line	:	1900 SILVER LAKE RD NW STE 110
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-1789
Country	:	US
Telephone Number	:	651-628-9566
Fax Number	:	651-628-0411

Provider Business Practice Location Address
First Line	:	7300 147TH ST W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-7541
Country	:	US
Telephone Number	:	952-997-3020
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	12/09/2024

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