Provider Demographics
NPI:1194156075
Name:WALKING TREE COUNSELING
Entity type:Organization
Organization Name:WALKING TREE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSTOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-368-5080
Mailing Address - Street 1:5002 147TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6685
Mailing Address - Country:US
Mailing Address - Phone:651-368-5080
Mailing Address - Fax:
Practice Address - Street 1:6230 10TH ST N
Practice Address - Street 2:STE#210
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6158
Practice Address - Country:US
Practice Address - Phone:651-368-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20849261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1508814625Medicaid
SC1508814625Medicaid