Provider Demographics
NPI:1073880068
Name:BASANT, SHANTE (LMFT, RN)
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:
Last Name:BASANT
Suffix:
Gender:F
Credentials:LMFT, RN
Other - Prefix:
Other - First Name:SHANTE
Other - Middle Name:
Other - Last Name:FAUSKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, RN
Mailing Address - Street 1:5995 OREN AVE N STE 209
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6777
Mailing Address - Country:US
Mailing Address - Phone:612-524-9237
Mailing Address - Fax:612-314-8317
Practice Address - Street 1:5995 OREN AVE N STE 209
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6777
Practice Address - Country:US
Practice Address - Phone:612-524-9237
Practice Address - Fax:612-314-8317
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2192-124106H00000X
MN2485250163W00000X
MN2306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1073880068Medicaid