=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174229223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JJ LINDSTROM PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2023
-----------------------------------------------------
Last Update Date | 05/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2313 6TH AVE SE
-----------------------------------------------------
City | WILLMAR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56201-4885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-963-5889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2313 6TH AVE SE
-----------------------------------------------------
City | WILLMAR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56201-4885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-963-5889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING & CODING SPECIALIST
-----------------------------------------------------
Name | PATRICK J LINDSTROM
-----------------------------------------------------
Credential | CMA
-----------------------------------------------------
Telephone | 161-296-3588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------