Christine Herzog, LPCC
Individual provider Active NPI Professional Counselor · Victoria, MN
NPI 1003277534 · NPPES record last updated Nov 7, 2018
Key facts
- NPI
- 1003277534
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- Practice address
- 1772 Stieger Lake LN Ste 220
Victoria, MN 55386-7723 - Phone
- (952) 443-4600
- NPI assigned
- Mar 10, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240402002480 | MN | Practitioner - Mental Health Counselor | 4385082916 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1179 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lorenz Clinic, LLC | Past |
Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/16506/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | Yes |
Addresses
Primary practice location
1772 Stieger Lake LN Ste 220
Victoria, MN 55386-7723
Mailing address
PO Box 51
Victoria, MN 55386-0051
Other providers in Victoria, MN
- Matthew Paul Green
- Erin Guyette
- Jeanna Hamlett
- Andrew Michael Hawkins
- Jessica Hendrickson
- His House Foundation
- Cynthia Marie Huntimer
- Heather Marlene Hurley Vangerud
- Inner Compass LLC
- Katherine B Jacobs
All providers in Victoria, MN · Professional Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.