Provider Demographics
NPI:1962156661
Name:OSTERUD, TAYLOR MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:OSTERUD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1696
Mailing Address - Country:US
Mailing Address - Phone:651-362-4908
Mailing Address - Fax:651-344-0515
Practice Address - Street 1:275 4TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1696
Practice Address - Country:US
Practice Address - Phone:651-362-4908
Practice Address - Fax:651-344-0515
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional