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Behavioral Health & Social Service Providers Psychologist Addiction (Substance Use Disorder)

Provider NPI: 1235240284

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 763-236-4375  Fax: 762-236-4370

Business Mailing Address:
Tel: 763-323-3394  Fax: --

NPI Information:
NPI: 1235240284
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103TA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103TA0400X





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