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General NPI Number Information
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NPI Number | 1053957357
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Entity Type | Organization
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Legal Business Name | M&T SISTERS OF SERENDIPITY PLLC
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 212A CENTRALAVE
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City | FARIBAULT
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State | MN
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Zip | 55021
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Country | US
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Telephone | 507-271-5089
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Fax |
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Provider Business Mailing Address
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Address Line | 512 4TH ST SW
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City | MEDFORD
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State | MN
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Zip | 55049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. MALLORY KATE FUCHS
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Credential | LADC
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Telephone | 507-271-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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