Provider Demographics
NPI:1639491749
Name:TORKELSON, JOHN CARL (MDIV, LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:TORKELSON
Suffix:
Gender:M
Credentials:MDIV, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 THIELEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9613
Mailing Address - Country:US
Mailing Address - Phone:763-515-4563
Mailing Address - Fax:763-497-0552
Practice Address - Street 1:703 THIELEN DR
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9613
Practice Address - Country:US
Practice Address - Phone:763-515-4563
Practice Address - Fax:763-497-0552
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist