Healthcare Provider Details

I. General information

NPI: 1396071486
Provider Name (Legal Business Name): NIDA GAUHAR M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 GRAND AVE
SAINT PAUL MN
55105-2629
US

IV. Provider business mailing address

1133 GRAND AVE
SAINT PAUL MN
55105-2629
US

V. Phone/Fax

Practice location:
  • Phone: 651-268-3627
  • Fax: 651-641-8635
Mailing address:
  • Phone: 651-268-3627
  • Fax: 651-641-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number433587
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: