MEDICARE: ISHA CALDWELL-DEES LADC, LPCC

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	4641	MN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	305991	MN

General Provider Information

NPI Number	:	1942910344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHA CALDWELL-DEES LADC, LPCC

Provider Business Mailing Address
First Line	:	106167 N 3800 RD
Second Line	:
City	:	OKEMAH
State	:	OK
Zip	:	74859-5178
Country	:	US
Telephone Number	:	612-460-7693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 14TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3111
Country	:	US
Telephone Number	:	612-460-7693
Fax Number	:

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

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	04/04/2026

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