Provider Demographics
NPI:1063943702
Name:BLUESTEM COUNSELING, PLLC
Entity type:Organization
Organization Name:BLUESTEM COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-321-1373
Mailing Address - Street 1:204 S 1ST ST
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-5506
Mailing Address - Country:US
Mailing Address - Phone:320-321-1373
Mailing Address - Fax:
Practice Address - Street 1:204 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-5506
Practice Address - Country:US
Practice Address - Phone:320-321-1373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21041251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1780006858Medicare PIN