Healthcare Provider Details

I. General information

NPI: 1932207396
Provider Name (Legal Business Name): NORTH STAR COUNSELING & MEDIATION SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 FAIRVIEW AVE NORTH STE B
ST PAUL MN
55113-1203
US

IV. Provider business mailing address

3116 FAIRVIEW AVE NORTH STE B
ST PAUL MN
55113-1203
US

V. Phone/Fax

Practice location:
  • Phone: 651-636-9100
  • Fax: 651-634-3712
Mailing address:
  • Phone: 651-636-9100
  • Fax: 651-634-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLP0594
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0628
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08378
License Number StateMN

VIII. Authorized Official

Name: EARL NOLTING
Title or Position: PRES
Credential: LIC PSYCHOLOGIST LP
Phone: 651-636-9100