Provider Demographics
NPI:1598491151
Name:PIVOTAL PROCESS LLC
Entity Type:Organization
Organization Name:PIVOTAL PROCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEZIERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:952-999-3196
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024
Mailing Address - Country:US
Mailing Address - Phone:952-999-3196
Mailing Address - Fax:
Practice Address - Street 1:18297 DUNBURY AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7242
Practice Address - Country:US
Practice Address - Phone:952-999-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty