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General NPI Number Information
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NPI Number | 1205441391
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Entity Type | Organization
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Legal Business Name | BE STILL SERVICES
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 913 STANLEY AVE
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City | CLOQUET
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State | MN
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Zip | 55720
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Country | US
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Telephone | 612-226-8719
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Fax | 651-666-1762
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Provider Business Mailing Address
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Address Line | 2724 STILLWATER ST
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City | WHITE BEAR TOWNSHIP
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State | MN
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Zip | 55110-2468
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Country | US
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Telephone | 612-226-8719
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Fax | 651-666-1762
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Authorized Official
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Title or Position | CLINIC DIRECTOR/OWNER
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Name | KARA EBERT
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Credential | LMFT
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Telephone | 612-226-8719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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