MEDICARE: NORTH STAR COUNSELING & MEDIATION SERVICES PSC

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	LP0594	MN
2	106H00000X	Marriage & Family Therapist	0628	MN
3	1041C0700X	Clinical Social Worker	08378	MN

General Provider Information

NPI Number	:	1932207396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR COUNSELING & MEDIATION SERVICES PSC

Provider Business Mailing Address
First Line	:	3116 FAIRVIEW AVE NORTH
Second Line	:	STE B
City	:	ST PAUL
State	:	MN
Zip	:	55113-1203
Country	:	US
Telephone Number	:	651-636-9100
Fax Number	:	651-634-3712

Provider Business Practice Location Address
First Line	:	3116 FAIRVIEW AVE NORTH
Second Line	:	STE B
City	:	ST PAUL
State	:	MN
Zip	:	55113-1203
Country	:	US
Telephone Number	:	651-636-9100
Fax Number	:	651-634-3712

Authorized Official
Title or Position	:	PRES
Name	:	EARL NOLTING
Credential	:	LIC PSYCHOLOGIST LP
Telephone Number	:	651-636-9100

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/11/2025

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