Provider Demographics
NPI:1164638730
Name:SKULSTAD, HANS CARL (LMFT)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:CARL
Last Name:SKULSTAD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 GOLDEN VALLEY RD STE 133
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4570
Mailing Address - Country:US
Mailing Address - Phone:763-546-8175
Mailing Address - Fax:763-546-2197
Practice Address - Street 1:7575 GOLDEN VALLEY RD STE 133
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4570
Practice Address - Country:US
Practice Address - Phone:763-546-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150158500Medicaid