Healthcare Provider Details

I. General information

NPI: 1780509133
Provider Name (Legal Business Name): DANIEL TSOLAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 W 30 1/2 ST APT 302
MINNEAPOLIS MN
55426-3547
US

IV. Provider business mailing address

8300 W 30 1/2 ST APT 302
MINNEAPOLIS MN
55426-3547
US

V. Phone/Fax

Practice location:
  • Phone: 612-405-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5802
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: