Healthcare Provider Details

I. General information

NPI: 1194643387
Provider Name (Legal Business Name): JOSEPH ROY ISMIL JR. MA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 E BELTLINE
HIBBING MN
55746-2305
US

IV. Provider business mailing address

905 SW 4TH AVE
GRAND RAPIDS MN
55744-3506
US

V. Phone/Fax

Practice location:
  • Phone: 218-293-4789
  • Fax: 218-327-0456
Mailing address:
  • Phone: 218-293-4789
  • Fax: 218-327-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5698
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: