Healthcare Provider Details

I. General information

NPI: 1558455659
Provider Name (Legal Business Name): LYNN HALMRAST MS LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 C 30TH AVE S
MOORHEAD MN
56560
US

IV. Provider business mailing address

1606 C 30TH AVE S
MOORHEAD MN
56560
US

V. Phone/Fax

Practice location:
  • Phone: 218-287-4338
  • Fax: 218-287-5928
Mailing address:
  • Phone: 218-287-4338
  • Fax: 218-287-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number80-5-22-91-107
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2662
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: