Healthcare Provider Details

I. General information

NPI: 1073880068
Provider Name (Legal Business Name): SHANTE SOOKHLALL HANSON LMFT, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANTE SOOKHLALL BASANT LMFT, RN

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
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 TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2485250
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2192-124
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1119070-30
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2306
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: