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General NPI Number Information
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NPI Number | 1033025077
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Entity Type | Individual
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Provider Name | MARK HANTLA LPCC
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Gender | Male
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Dates
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Enumeration Date | 08/20/2026
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 771 RAYMOND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55114-1522
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Country | US
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Telephone | 651-243-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 4624 BLOOMINGTON AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3663
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Country | US
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Telephone | 712-899-7416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5800
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License Number State | MN
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