Healthcare Provider Details

I. General information

NPI: 1952443103
Provider Name (Legal Business Name): LOIS JUNE FLOR MA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BROADWAY AVENUE NORTH FIVE COUNTY MENTAL HEALTH CENTER BRAHAM
BRAHAM MN
55006
US

IV. Provider business mailing address

PO BOX 287 521 BROADWAY AVENUE NORTH
BRAHAM MN
55006
US

V. Phone/Fax

Practice location:
  • Phone: 320-396-3333
  • Fax: 320-396-3363
Mailing address:
  • Phone: 320-396-3333
  • Fax: 320-396-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7571
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: