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General NPI Number Information
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NPI Number | 1013013531
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Entity Type | Organization
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Legal Business Name | MARIPOSA PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 322 ELTON HILLS DR
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City | ROCHESTER
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State | MN
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Zip | 55901
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Country | US
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Telephone | 507-424-4016
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Fax | 507-424-4017
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Provider Business Mailing Address
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Address Line | 322 ELTON HILLS DR
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City | ROCHESTER
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State | MN
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Zip | 55901
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Country | US
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Telephone | 507-424-4016
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Fax | 507-424-4017
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Authorized Official
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Title or Position | OWNER
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Name | TERRI L ORDHAL
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Credential | PSY D LP
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Telephone | 507-424-4016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4469
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License Number State | MN
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