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General NPI Number Information
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NPI Number | 1598491151
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Entity Type | Organization
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Legal Business Name | PIVOTAL PROCESS LLC
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 18297 DUNBURY AVE
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City | FARMINGTON
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State | MN
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Zip | 55024-7242
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Country | US
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Telephone | 952-999-3196
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 213
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City | FARMINGTON
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State | MN
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Zip | 55024
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Country | US
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Telephone | 952-999-3196
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL COUNSELOR
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Name | KELSEY JEZIERSKI
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Credential | MA, LPCC
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Telephone | 952-999-3196
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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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