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NPI Code Detail

MEDICARE: ST. CROIX COUNSELING

MEDICARE: ST. CROIX COUNSELING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker20166MN

General Provider Information

NPI Number : 1568729358
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. CROIX COUNSELING
Provider Business Mailing Address
First Line : PO BOX 144
Second Line : 3394 LAKE ELMO AVE. NO.
City : LAKE ELMO
State : MN
Zip : 55042-0144
Country : US
Telephone Number : 651-303-5522
Fax Number :
Provider Business Practice Location Address
First Line : 3394 LAKE ELMO AVE N
Second Line :
City : LAKE ELMO
State : MN
Zip : 55042-4438
Country : US
Telephone Number : 651-303-5522
Fax Number :
Authorized Official
Title or Position : LICSW/OWNER/THERAPIST
Name : SUSAN WHALEN
Credential :
Telephone Number : 651-303-5522
Provider Enumeration Date : 04/18/2012
Last Update Date : 04/18/2012

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Directions to “ST. CROIX COUNSELING ” Practice Location

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