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General NPI Number Information
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NPI Number | 1205903812
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Entity Type | Organization
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Legal Business Name | MARRIAGE & FAMILY WELLNES CENTER, INC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 55TH ST NW SUITE 2
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City | ROCHESTER
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State | MN
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Zip | 55901-4187
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Country | US
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Telephone | 507-288-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 55TH ST NW SUITE 2
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City | ROCHESTER
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State | MN
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Zip | 55901-4187
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Country | US
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Telephone | 507-288-3118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID L JAMISON
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Credential | M.DIV, MS, D.MIN,
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Telephone | 507-288-3118
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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 | 175
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License Number State | MN
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