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General NPI Number Information
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NPI Number | 1477829737
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Entity Type | Organization
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Legal Business Name | KRISMA COUNSELING INC.
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 112 W 1ST ST SUITE 104
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City | FAIRMONT
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State | MN
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Zip | 56031-1743
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Country | US
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Telephone | 507-399-2149
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Fax | 507-399-2159
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Provider Business Mailing Address
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Address Line | 112 W 1ST ST SUITE 104
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City | FAIRMONT
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State | MN
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Zip | 56031-1743
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Country | US
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Telephone | 507-399-2149
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Fax | 507-399-2159
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Authorized Official
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Title or Position | CO-OWMER
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Name | MR. MAURICE LEE SHOEN
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Credential | LICSW
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Telephone | 507-399-2149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17553
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License Number State | MN
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