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General NPI Number Information
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NPI Number | 1083740286
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Entity Type | Individual
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Provider Name | MARIE WELBORN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1516 W LAKE ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2554
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Country | US
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Telephone | 612-824-4123
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Fax | 952-829-8005
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Provider Business Mailing Address
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Address Line | PO BOX 24625
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City | EDINA
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State | MN
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Zip | 55424-0625
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Country | US
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Telephone | 612-824-4123
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Fax | 952-829-8005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4371
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY15185
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License Number State | CA
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