Provider Demographics
NPI:1184714461
Name:HORSTMANN, DAVID WILLIAM (MS, LP, LMFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:HORSTMANN
Suffix:
Gender:M
Credentials:MS, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6251
Mailing Address - Country:US
Mailing Address - Phone:651-641-0516
Mailing Address - Fax:
Practice Address - Street 1:570 ASBURY ST
Practice Address - Street 2:STE. 103
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1849
Practice Address - Country:US
Practice Address - Phone:651-641-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1951103T00000X
MN0358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1223716OtherUNITED BEHAVIORAL HEALTH
MN57389HOOtherBLUE CROSS BLUE SHIELD