Provider Demographics
NPI:1427815968
Name:WHITESTONE WELLNESS LLC
Entity type:Organization
Organization Name:WHITESTONE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:HARTMAN
Authorized Official - Last Name:VALINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADC
Authorized Official - Phone:763-439-1166
Mailing Address - Street 1:22501 JASON AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9160
Mailing Address - Country:US
Mailing Address - Phone:763-439-1166
Mailing Address - Fax:
Practice Address - Street 1:22501 JASON AVE N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9160
Practice Address - Country:US
Practice Address - Phone:763-439-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty