Healthcare Provider Details

I. General information

NPI: 1740746007
Provider Name (Legal Business Name): LINDSAY GEPHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY BATTUELLO

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 UNIVERSITY AVE W
SAINT PAUL MN
55104-4125
US

IV. Provider business mailing address

1246 UNIVERSITY AVE W
SAINT PAUL MN
55104-4125
US

V. Phone/Fax

Practice location:
  • Phone: 651-309-0341
  • Fax:
Mailing address:
  • Phone: 651-309-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1207
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303707
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1207
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: