Provider Demographics
NPI:1558123851
Name:STONE, CONNOR WILLIAM FADELL (LPCC)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:WILLIAM FADELL
Last Name:STONE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 TEXAS AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3615
Mailing Address - Country:US
Mailing Address - Phone:952-913-7773
Mailing Address - Fax:
Practice Address - Street 1:16182 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3408
Practice Address - Country:US
Practice Address - Phone:651-330-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health