Healthcare Provider Details

I. General information

NPI: 1689488470
Provider Name (Legal Business Name): KRISTOF CHARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 INWOOD AVE N
OAKDALE MN
55128-6625
US

IV. Provider business mailing address

200 W 96TH ST APT 3K
MINNEAPOLIS MN
55420-4330
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-1312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: