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NPI 1841010907

NPI 1841010907 : TERRANCE LEE OSTRANDER MA, LPCC : SAINT PAUL, MN

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General NPI Number Information
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    NPI Number           |    1841010907
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    Entity Type          |    Individual 
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    Provider Name        |    TERRANCE LEE OSTRANDER MA, LPCC
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    10/14/2024
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    Last Update Date     |    10/14/2024
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Provider Practice Location Address
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    Address Line         |    1114 GRAND AVE 
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    City                 |    SAINT PAUL
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    State                |    MN
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    Zip                  |    55105-2628
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    Country              |    US
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    Telephone            |    612-284-1848
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    2078 RICHARD AVE 
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    City                 |    SAINT PAUL
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    State                |    MN
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    Zip                  |    55110-4728
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    Country              |    US
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    Telephone            |    612-203-5099
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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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       |    CC04578
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    License Number State |    MN
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