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General NPI Number Information
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NPI Number | 1063943702
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Entity Type | Organization
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Legal Business Name | BLUESTEM COUNSELING, PLLC
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 204 S 1ST ST
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City | MONTEVIDEO
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State | MN
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Zip | 56265-5506
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Country | US
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Telephone | 320-321-1373
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S 1ST ST PO BOX 71
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City | MONTEVIDEO
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State | MN
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Zip | 56265-5506
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Country | US
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Telephone | 320-321-1373
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Fax |
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Authorized Official
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Title or Position | OWNER/MENTAL HEALTH PROFESSIONAL
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Name | MS. JENNIFER LEE BRIEST
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Credential | LICSW
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Telephone | 320-321-1373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 21041
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License Number State | MN
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