MEDICARE: MR. NATHANIEL JOSEPH VAN HEUVELN MS

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
1	101YM0800X	Mental Health Counselor	3246	MN

General Provider Information

NPI Number	:	1912753120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL JOSEPH VAN HEUVELN MS

Provider Business Mailing Address
First Line	:	600 25TH AVE S STE 203
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-4866
Country	:	US
Telephone Number	:	320-204-4430
Fax Number	:	320-204-4707

Provider Business Practice Location Address
First Line	:	600 25TH AVE S STE 203
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-4866
Country	:	US
Telephone Number	:	320-204-4430
Fax Number	:	320-204-4707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	02/12/2026

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