Healthcare Provider Details

I. General information

NPI: 1962011635
Provider Name (Legal Business Name): CHAD ANDREW TALBOT LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 UPLAND LN N STE 210
MAPLE GROVE MN
55369-5777
US

IV. Provider business mailing address

19591 STATION ST APT 308
BIG LAKE MN
55309-9436
US

V. Phone/Fax

Practice location:
  • Phone: 612-915-0049
  • Fax:
Mailing address:
  • Phone: 612-242-2519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4297
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: