Provider Demographics
NPI:1639747918
Name:FIELDS OF GRACE COUNSELING AND WELLNESS INC
Entity Type:Organization
Organization Name:FIELDS OF GRACE COUNSELING AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-236-0976
Mailing Address - Street 1:310 1/2 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082
Mailing Address - Country:US
Mailing Address - Phone:651-236-0976
Mailing Address - Fax:
Practice Address - Street 1:310 1/2 MAIN ST S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-236-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty