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General NPI Number Information
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NPI Number | 1457066284
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Entity Type | Organization
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Legal Business Name | COSAN LEIGHIS LLC
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 145 2ND ST W
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City | WABASHA
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State | MN
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Zip | 55981-1245
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Country | US
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Telephone | 715-279-8591
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Fax |
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Provider Business Mailing Address
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Address Line | 145 2ND ST W
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City | WABASHA
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State | MN
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Zip | 55981-1245
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Country | US
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Telephone | 715-279-8591
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | DR. COLLEEN ETZBACH
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Credential | RHD
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Telephone | 715-279-8591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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