Provider Demographics
NPI:1164992301
Name:VENTHOUSE COUNSELING
Entity Type:Organization
Organization Name:VENTHOUSE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC,LADC
Authorized Official - Phone:612-562-6766
Mailing Address - Street 1:6656 PINE CREST TRL S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4679
Mailing Address - Country:US
Mailing Address - Phone:612-562-6766
Mailing Address - Fax:612-638-6601
Practice Address - Street 1:8530 EAGLE POINT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8648
Practice Address - Country:US
Practice Address - Phone:612-562-6766
Practice Address - Fax:612-638-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty