Provider Demographics
NPI:1295270429
Name:NOSBUSCH, MAKENNA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:
Last Name:NOSBUSCH
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 ROSEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3633
Mailing Address - Country:US
Mailing Address - Phone:763-438-6074
Mailing Address - Fax:
Practice Address - Street 1:6726 WALKER STREET
Practice Address - Street 2:
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:612-444-1520
Practice Address - Fax:612-416-3151
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health