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General NPI Number Information
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NPI Number | 1316400740
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Entity Type | Organization
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Legal Business Name | SUSAN HOISINGTON COUNSELING LLC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1068 LAKE ST S STE 102
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City | FOREST LAKE
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State | MN
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Zip | 55025-2633
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Country | US
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Telephone | 612-597-3133
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 BIBEAU RD
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3600
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Country | US
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Telephone | 612-597-3133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN HOISINGTON
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Credential | PSY.D
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Telephone | 612-597-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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