Healthcare Provider Details

I. General information

NPI: 1912872466
Provider Name (Legal Business Name): EZER PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14025 COUNTY ROAD 140
COLD SPRING MN
56320-9818
US

IV. Provider business mailing address

14025 COUNTY ROAD 140
COLD SPRING MN
56320-9818
US

V. Phone/Fax

Practice location:
  • Phone: 612-662-1421
  • Fax:
Mailing address:
  • Phone: 612-662-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HALLIE MARIE ORTON
Title or Position: SOCIAL WORKER
Credential: MSW, LICSW
Phone: 612-662-1421