Healthcare Provider Details

I. General information

NPI: 1255888947
Provider Name (Legal Business Name): MOLLY NEWMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 1ST ST STE 270
NEW RICHMOND WI
54017-1770
US

IV. Provider business mailing address

11634 IVYWOOD CIR
WOODBURY MN
55129-7796
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-4840
  • Fax: 715-254-9459
Mailing address:
  • Phone: 763-234-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01213
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6259-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: