Provider Demographics
NPI:1366629081
Name:MISHACOFF, NATASCHA LYNN (MS LPCC)
Entity Type:Individual
Prefix:MRS
First Name:NATASCHA
Middle Name:LYNN
Last Name:MISHACOFF
Suffix:
Gender:F
Credentials:MS LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVENUE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:280 SMITH AVE N
Practice Address - Street 2:DOCTOR'S PROFESSIONAL BUILDING
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2424
Practice Address - Country:US
Practice Address - Phone:651-241-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC 260101YM0800X
MN00260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health