Provider Demographics
NPI:1316400740
Name:SUSAN HOISINGTON COUNSELING LLC
Entity Type:Organization
Organization Name:SUSAN HOISINGTON COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOISINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:612-597-3133
Mailing Address - Street 1:1324 BIBEAU RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3600
Mailing Address - Country:US
Mailing Address - Phone:612-597-3133
Mailing Address - Fax:
Practice Address - Street 1:1068 LAKE ST S STE 102
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2633
Practice Address - Country:US
Practice Address - Phone:612-597-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1104974674OtherPSYCHOLOGY