Provider Demographics
NPI:1508314071
Name:NEST PROFESSIONAL SERVICE CORP
Entity Type:Organization
Organization Name:NEST PROFESSIONAL SERVICE CORP
Other - Org Name:THE NEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARMONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:651-425-9297
Mailing Address - Street 1:333 MAIN ST. N
Mailing Address - Street 2:SUITE #110
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4903
Mailing Address - Country:US
Mailing Address - Phone:651-300-8135
Mailing Address - Fax:651-413-3380
Practice Address - Street 1:333 MAIN ST. N
Practice Address - Street 2:SUITE #110
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4903
Practice Address - Country:US
Practice Address - Phone:651-300-8135
Practice Address - Fax:651-413-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 5418251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health