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Behavioral Health & Social Service Providers Counselor Professional

Provider NPI: 1457864605

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
2495 MAPLEWOOD DR STE 312  MAPLEWOOD, MN 55109-1985 US
Tel: 651-760-3109  Fax: 651-967-9417

Business Mailing Address:
2495 MAPLEWOOD DR STE 312  MAPLEWOOD, MN 55109-1985 US
Tel: 651-760-3109  Fax: 651-967-9417

NPI Information:
NPI: 1457864605
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N101YP2500XBehavioral Health & Social Service Providers
Y103TB0200XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103TB0200X





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