Provider Demographics
NPI:1023564093
Name:MASTIN, JUSTINE WELCH (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:WELCH
Last Name:MASTIN
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:MALKE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5510 WASHBURN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2437
Mailing Address - Country:US
Mailing Address - Phone:612-616-5782
Mailing Address - Fax:
Practice Address - Street 1:6640 LYNDALE AVE S STE 110
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:612-324-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303216101YA0400X
MN2927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)