MEDICARE: EZER PSYCHOTHERAPY, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1912872466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZER PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	14025 COUNTY ROAD 140
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-9818
Country	:	US
Telephone Number	:	612-662-1421
Fax Number	:

Provider Business Practice Location Address
First Line	:	14025 COUNTY ROAD 140
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-9818
Country	:	US
Telephone Number	:	612-662-1421
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	HALLIE MARIE ORTON
Credential	:	MSW, LICSW
Telephone Number	:	612-662-1421

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	06/14/2026

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