Provider Demographics
NPI:1932207396
Name:NORTH STAR COUNSELING & MEDIATION SERVICES PSC
Entity Type:Organization
Organization Name:NORTH STAR COUNSELING & MEDIATION SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLTING
Authorized Official - Suffix:
Authorized Official - Credentials:LIC PSYCHOLOGIST LP
Authorized Official - Phone:651-636-9100
Mailing Address - Street 1:3116 FAIRVIEW AVE NORTH
Mailing Address - Street 2:STE B
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1203
Mailing Address - Country:US
Mailing Address - Phone:651-636-9100
Mailing Address - Fax:651-634-3712
Practice Address - Street 1:3116 FAIRVIEW AVE NORTH
Practice Address - Street 2:STE B
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-1203
Practice Address - Country:US
Practice Address - Phone:651-636-9100
Practice Address - Fax:651-634-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0594101YM0800X
MN083781041C0700X
MN0628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO4151Medicare ID - Type Unspecified