Healthcare Provider Details

I. General information

NPI: 1982920609
Provider Name (Legal Business Name): INSTITUTE FOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 W CLARK ST
ALBERT LEA MN
56007-2548
US

IV. Provider business mailing address

244 W CLARK ST
ALBERT LEA MN
56007-2548
US

V. Phone/Fax

Practice location:
  • Phone: 507-373-7913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID A. LARSON
Title or Position: OWNER
Credential:
Phone: 507-373-7913