Healthcare Provider Details

I. General information

NPI: 1215518998
Provider Name (Legal Business Name): MARISSA JOELLE STELZER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA JOELLE HOLST N/A

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SNELLING AVE N STE 400
ROSEVILLE MN
55113-1783
US

IV. Provider business mailing address

4603 CANVASBACK ST
BIG LAKE MN
55309-8217
US

V. Phone/Fax

Practice location:
  • Phone: 763-525-1746
  • Fax: 763-486-4439
Mailing address:
  • Phone: 651-338-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2803
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: