Provider Demographics
NPI:1568729358
Name:ST. CROIX COUNSELING
Entity Type:Organization
Organization Name:ST. CROIX COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW/OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-303-5522
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:3394 LAKE ELMO AVE. NO.
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-0144
Mailing Address - Country:US
Mailing Address - Phone:651-303-5522
Mailing Address - Fax:
Practice Address - Street 1:3394 LAKE ELMO AVE N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-4438
Practice Address - Country:US
Practice Address - Phone:651-303-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty