Provider Demographics
NPI:1477622389
Name:FORSELL, DAVID LARS (LPCC, NCAC II, LADC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LARS
Last Name:FORSELL
Suffix:
Gender:M
Credentials:LPCC, NCAC II, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 MINNESOTA ST
Mailing Address - Street 2:SUITE E-1255
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1314
Mailing Address - Country:US
Mailing Address - Phone:612-670-1405
Mailing Address - Fax:651-653-1137
Practice Address - Street 1:332 MINNESOTA ST
Practice Address - Street 2:SUITE E-1255
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1314
Practice Address - Country:US
Practice Address - Phone:612-670-1405
Practice Address - Fax:651-653-1137
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300749101YA0400X
MNCC00057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional