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General NPI Number Information
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NPI Number | 1699202952
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Entity Type | Organization
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Legal Business Name | 4 COUNSEL, P.A.
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11292 86TH AVE N STE 106
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4510
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Country | US
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Telephone | 952-300-5908
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Fax |
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Provider Business Mailing Address
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Address Line | 11292 86TH AVE N STE 106
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4510
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Country | US
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Telephone | 952-300-5908
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINE DOTEN
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Credential | MA, LPCC
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Telephone | 952-300-5908
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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 | CC01429
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License Number State | MN
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