Provider Demographics
NPI:1558177337
Name:NOVA NORTH THERAPY LLC
Entity type:Organization
Organization Name:NOVA NORTH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JERNBERG PESCHGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-334-4457
Mailing Address - Street 1:2811 113TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3402
Mailing Address - Country:US
Mailing Address - Phone:952-334-4457
Mailing Address - Fax:
Practice Address - Street 1:821 MEANDER CT
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:MN
Practice Address - Zip Code:55340-4549
Practice Address - Country:US
Practice Address - Phone:952-334-4457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty