=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962557496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNSELING SERVICES OF SOUTHERN MINNESOTA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1306 MARSHALL ST
-----------------------------------------------------
City | SAINT PETER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56082-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-931-8040
-----------------------------------------------------
Fax | 507-931-8060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1306 MARSHALL ST
-----------------------------------------------------
City | SAINT PETER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56082-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-931-8040
-----------------------------------------------------
Fax | 507-931-8060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HUMAN RESOURCES/CREDENTIALING
-----------------------------------------------------
Name | NATALEE L ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-931-8040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | LP3791
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1150
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1424
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10695
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | LP4430
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1290
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 11076
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------