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General NPI Number Information
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NPI Number | 1740044965
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Entity Type | Organization
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Legal Business Name | NORTHLIGHT MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 4047 HIGHWAY 61 N STE 202
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4631
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Country | US
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Telephone | 651-237-3102
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Fax |
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Provider Business Mailing Address
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Address Line | 4047 HIGHWAY 61 N STE 202
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4631
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Country | US
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Telephone | 651-237-3102
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Fax | 651-383-1423
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DUSTIN JENSEN
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Credential |
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Telephone | 651-888-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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