MEDICARE: COUNSELING SERVICES OF SOUTHERN MINNESOTA, INC

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	103T00000X	Psychologist	LP3791	MN
2	106H00000X	Marriage & Family Therapist	1150	MN
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	106H00000X	Marriage & Family Therapist	1424	MN
5	1041C0700X	Clinical Social Worker	10695	MN
6	103T00000X	Psychologist	LP4430	MN
7	106H00000X	Marriage & Family Therapist	1290	MN
8	1041C0700X	Clinical Social Worker	11076	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	396R7CO	OTHER	MN	BCBS LMFT GROUP #
2	8G343CO	OTHER	MN	BCBS LICSW GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	81D54CO	OTHER	MN	BCBS DR LEVEL LP GROUP #
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962557496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING SERVICES OF SOUTHERN MINNESOTA, INC

Provider Business Mailing Address
First Line	:	1306 MARSHALL ST
Second Line	:
City	:	SAINT PETER
State	:	MN
Zip	:	56082-4500
Country	:	US
Telephone Number	:	507-931-8040
Fax Number	:	507-931-8060

Provider Business Practice Location Address
First Line	:	1306 MARSHALL ST
Second Line	:
City	:	SAINT PETER
State	:	MN
Zip	:	56082-4500
Country	:	US
Telephone Number	:	507-931-8040
Fax Number	:	507-931-8060

Authorized Official
Title or Position	:	HUMAN RESOURCES/CREDENTIALING
Name	:	NATALEE L ANDERSON
Credential	:
Telephone Number	:	507-931-8040

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/15/2025

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