Facts
- Status
- A
- Credential
- LMFT
- Type
- Individual
- Enumeration date
- 2024-01-25
- Last updated
- 2024-04-17
Specialties
Licenses
- License MN
- 4398
Location
- Practice location
- 2125 1ST ST S
- City
- WILLMAR MN
- Postal code
- 562014256
- Phone
- 320-444-7241
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.