Healthcare Provider Details

I. General information

NPI: 1972452845
Provider Name (Legal Business Name): NICOLE SCALES LINDBERG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 PARK GLEN RD
ST LOUIS PARK MN
55416-4758
US

IV. Provider business mailing address

715 MAPLE HILLS DR APT B
MAPLEWOOD MN
55117-2865
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-9034
  • Fax:
Mailing address:
  • Phone: 612-314-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE SUSAN SCALES LINDBERG
Title or Position: OUTPATIENT MENTAL HEALTH THERAPIST
Credential: MSW, MA
Phone: 612-314-9034