Healthcare Provider Details

I. General information

NPI: 1518378470
Provider Name (Legal Business Name): KNUSTON COUNSELING AND SEMINARS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 1ST ST SW SUITE NUMBER #225
WILLMAR MN
56201-4243
US

IV. Provider business mailing address

1604 1ST ST S SUITE NUMBER #225
WILLMAR MN
56201-4243
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-1121
  • Fax: 320-235-0099
Mailing address:
  • Phone: 320-235-1121
  • Fax: 320-235-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1151
License Number StateMN

VIII. Authorized Official

Name: MRS. ELOUISE A KNUTSON
Title or Position: OWNER, SUPERVISOR
Credential: LICSW
Phone: 320-235-1121