=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104782929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAY AWHILE THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2025
-----------------------------------------------------
Last Update Date | 12/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13394 BRADLEY BLVD
-----------------------------------------------------
City | BECKER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55308-9534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-356-8650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13394 BRADLEY BLVD
-----------------------------------------------------
City | BECKER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55308-9534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | JAMIE J CHAPIN
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 651-356-8650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------