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General NPI Number Information
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NPI Number | 1265768337
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Entity Type | Individual
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Provider Name | NATALIE MARIE MARR L.P.
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Gender | Female
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 6121 EXCELSIOR BLVD STE 101A
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2752
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Country | US
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Telephone | 612-440-8742
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Fax | 716-531-9060
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Provider Business Mailing Address
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Address Line | PO BOX 490171
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City | BLAINE
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State | MN
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Zip | 55449-0171
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Country | US
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Telephone | 17637626988
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Fax |
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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 | 4960
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License Number State | MN
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