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General NPI Number Information
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NPI Number | 1285198663
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Entity Type | Organization
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Legal Business Name | CENTER FOR LIFE TRANSITIONS
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 38 24TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4340
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Country | US
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Telephone | 320-746-0025
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Fax |
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Provider Business Mailing Address
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Address Line | 38 24TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4340
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Country | US
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Telephone | 320-746-0025
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Fax |
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Authorized Official
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Title or Position | BOARD CHAIR
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Name | MS. ROXANN J STORMS
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Credential | LICSW
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Telephone | 320-746-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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