Provider Demographics
NPI:1932325735
Name:MISHEK, CHARLES JOSEPH (MA, LP, LADC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MISHEK
Suffix:
Gender:M
Credentials:MA, LP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:445 ETNA ST
Mailing Address - Street 2:SUITE 55
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5857
Mailing Address - Country:US
Mailing Address - Phone:651-254-9443
Mailing Address - Fax:651-254-9238
Practice Address - Street 1:445 ETNA ST
Practice Address - Street 2:SUITE 55
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5857
Practice Address - Country:US
Practice Address - Phone:651-254-9443
Practice Address - Fax:651-254-9238
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300312101YA0400X
MNLP 2598103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)