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General NPI Number Information
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NPI Number | 1356391015
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Entity Type | Individual
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Provider Name | MARY KIM HELLIER PHD LP
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 1900 CENTRACARE CIRCLE
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-229-4945
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Fax | 320-229-5109
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Provider Business Mailing Address
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Address Line | 1406 6TH AVE N
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-251-2700
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Fax | 320-229-5109
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | LP3052
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License Number State | MN
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