Healthcare Provider Details

I. General information

NPI: 1801567094
Provider Name (Legal Business Name): CHRISTINA NULTY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 CEDAR LAKE RD S STE 112
ST LOUIS PARK MN
55416-1481
US

IV. Provider business mailing address

5801 CEDAR LAKE RD S STE 112
ST LOUIS PARK MN
55416-1481
US

V. Phone/Fax

Practice location:
  • Phone: 612-662-6236
  • Fax: 612-500-4274
Mailing address:
  • Phone: 612-662-6236
  • Fax: 612-500-4274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC05470
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: