Provider Demographics
NPI:1699362145
Name:EVENSTAD, BROGAN RENEE (LPCC)
Entity Type:Individual
Prefix:
First Name:BROGAN
Middle Name:RENEE
Last Name:EVENSTAD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 1ST AVE NW STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2830
Mailing Address - Country:US
Mailing Address - Phone:651-233-3091
Mailing Address - Fax:
Practice Address - Street 1:300 1ST STREET NW
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:651-233-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC03014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty