Healthcare Provider Details

I. General information

NPI: 1639747918
Provider Name (Legal Business Name): FIELDS OF GRACE COUNSELING AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 4TH ST S # 103
STILLWATER MN
55082-4966
US

IV. Provider business mailing address

522 4TH ST S # 103
STILLWATER MN
55082-4966
US

V. Phone/Fax

Practice location:
  • Phone: 651-300-2088
  • Fax:
Mailing address:
  • Phone: 651-300-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. CARISSA STEPAN
Title or Position: OWNER
Credential: PSYD
Phone: 651-236-0976