Provider Demographics
NPI:1518781095
Name:SHANTE PLLC
Entity type:Organization
Organization Name:SHANTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:SOOKHLALL
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, RN
Authorized Official - Phone:612-524-9237
Mailing Address - Street 1:5995 OREN AVE N STE 209
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6777
Mailing Address - Country:US
Mailing Address - Phone:612-524-9237
Mailing Address - Fax:612-314-8317
Practice Address - Street 1:5995 OREN AVE N STE 209
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6777
Practice Address - Country:US
Practice Address - Phone:612-524-9237
Practice Address - Fax:612-314-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty