=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508386939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATTI VENEKAMP COUNSELING SERVICES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 LAKE ST S STE 101
-----------------------------------------------------
City | LONG PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56347-7121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-732-7111
-----------------------------------------------------
Fax | 320-732-9038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 LAKE ST S STE 101
-----------------------------------------------------
City | LONG PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56347-7121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-732-7111
-----------------------------------------------------
Fax | 320-732-9038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | PATTI ANN VENEKAMP
-----------------------------------------------------
Credential | LICENSED PSYCHOLOGIS
-----------------------------------------------------
Telephone | 320-732-7111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | LP2812
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------