Healthcare Provider Details

I. General information

NPI: 1831739788
Provider Name (Legal Business Name): FULL CIRCLE COUNSELING AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 AUSTIN RD STE 1
OWATONNA MN
55060-4544
US

IV. Provider business mailing address

1880 AUSTIN RD STE 1
OWATONNA MN
55060-4544
US

V. Phone/Fax

Practice location:
  • Phone: 507-214-2016
  • Fax: 507-214-2017
Mailing address:
  • Phone: 507-214-2016
  • Fax: 507-214-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CHERYL D BISSONETTE
Title or Position: VICE PRESIDENT
Credential: MA, LMFT
Phone: 507-214-2016