Healthcare Provider Details

I. General information

NPI: 1891862488
Provider Name (Legal Business Name): CINDY LEE KOUBSKY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 STEARNS WAY
SAINT CLOUD MN
56303-4491
US

IV. Provider business mailing address

2025 STEARNS WAY
SAINT CLOUD MN
56303-4491
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-3540
  • Fax: 320-253-1475
Mailing address:
  • Phone: 320-253-3540
  • Fax: 320-253-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1047
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: