Basic Information
| Provider Information | |||||||||
| NPI: | 1891725883 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KNOW THE TRUTH MINISTRIES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHLAND COUNSELING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7945 STONE CREEK DR | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553174605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7945 STONE CREEK DR | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553174605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743999 | ||||||||
| FaxNumber: | 9529743780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAUMCHEN | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9529743999 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PSY. D., LP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LP3478 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | LP2178 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | LP3948 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | LP4675 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | LICSW9379 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TC0700X | LP2484 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 4206631-00 | 05 | MN | MEDICAID |