Provider Demographics
NPI:1538882964
Name:BRUTEJCEK, NATHANIEL JOHN (LPCC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JOHN
Last Name:BRUTEJCEK
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3248
Mailing Address - Country:US
Mailing Address - Phone:651-368-0797
Mailing Address - Fax:
Practice Address - Street 1:1314 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3248
Practice Address - Country:US
Practice Address - Phone:651-268-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health