Individual
STACY NATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8060 HWY 55 STE 100, ROCKFORD, MN 55373-9407
(612) 597-0675
Mailing address
10755 93RD AVE N, MAPLE GROVE, MN 55369-4109
(612) 597-0675
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/15/2025
Last updated
04/15/2025
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