=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275245706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY RAE MENSINK LADC, LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2022
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2970 JUDICIAL RD STE 100
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-7822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-515-9246
-----------------------------------------------------
Fax | 612-444-3292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2970 JUDICIAL RD STE 100
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-7822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-515-9246
-----------------------------------------------------
Fax | 612-444-3292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 305760
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 3973
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------