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General NPI Number Information
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NPI Number | 1912872466
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Entity Type | Organization
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Legal Business Name | EZER PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 11/16/2025
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Provider Practice Location Address
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Address Line | 511 S 4TH ST APT 415
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-2213
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Country | US
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Telephone | 612-709-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 511 S 4TH ST APT 415
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-2213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | HALLIE MARIE ORTON
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Credential | MSW, LICSW
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Telephone | 612-662-1421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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