Healthcare Provider Details

I. General information

NPI: 1124743117
Provider Name (Legal Business Name): ANDREW DEAN VAN RULER MS, LPCC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 11TH AVE NW STE 300
ROCHESTER MN
55901-2297
US

IV. Provider business mailing address

602 11TH AVE NW STE 300
ROCHESTER MN
55901-2297
US

V. Phone/Fax

Practice location:
  • Phone: 507-292-1379
  • Fax: 651-383-4929
Mailing address:
  • Phone: 507-292-1379
  • Fax: 651-383-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306105
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4685
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: