Healthcare Provider Details

I. General information

NPI: 1518781095
Provider Name (Legal Business Name): SHANTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 OREN AVE N STE 108
STILLWATER MN
55082-5302
US

IV. Provider business mailing address

5995 OREN AVE N STE 108
STILLWATER MN
55082-5302
US

V. Phone/Fax

Practice location:
  • Phone: 612-524-9237
  • Fax: 612-314-8317
Mailing address:
  • Phone: 612-524-9237
  • Fax: 612-314-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANTE SOOKHLALL HANSON
Title or Position: OWNER
Credential: LMFT, RN
Phone: 612-524-9237