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General NPI Number Information
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NPI Number | 1164992301
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Entity Type | Organization
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Legal Business Name | VENTHOUSE COUNSELING
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 8530 EAGLE POINT BLVD STE 100
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City | LAKE ELMO
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State | MN
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Zip | 55042-8648
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Country | US
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Telephone | 612-562-6766
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Fax | 612-638-6601
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Provider Business Mailing Address
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Address Line | 6656 PINE CREST TRL S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4679
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Country | US
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Telephone | 612-562-6766
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Fax | 612-638-6601
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Authorized Official
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Title or Position | OWNER
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Name | JASON MICHAEL WALTER
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Credential | LPCC,LADC
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Telephone | 612-562-6766
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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 |
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License Number State |
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