Healthcare Provider Details

I. General information

NPI: 1023875366
Provider Name (Legal Business Name): TELOS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8673 EAGLE POINT BLVD STE 203
LAKE ELMO MN
55042-8661
US

IV. Provider business mailing address

4141 OLD SIBLEY MEMORIAL HWY
EAGAN MN
55122-1996
US

V. Phone/Fax

Practice location:
  • Phone: 612-217-0650
  • Fax:
Mailing address:
  • Phone: 612-217-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RYAN DREWIANKA
Title or Position: OWNER
Credential: LPPC
Phone: 952-240-1849