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General NPI Number Information
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NPI Number | 1376295444
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Entity Type | Organization
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Legal Business Name | VISTA NORTH COUNSELING
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 860 BLUE GENTIAN RD STE 200
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City | EAGAN
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State | MN
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Zip | 55121-1567
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Country | US
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Telephone | 612-208-3807
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1173
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City | LAKEVILLE
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State | MN
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Zip | 55044-1173
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TESSA HORSTMANN
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Credential | MA, LPCC
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Telephone | 612-751-1011
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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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