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General NPI Number Information
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NPI Number | 1689223760
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Entity Type | Individual
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Provider Name | MICHAEL FRIESEN
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 113 W MAIN ST
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City | WACONIA
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State | MN
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Zip | 55387-1023
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Country | US
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Telephone | 855-454-2463
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Fax |
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Provider Business Mailing Address
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Address Line | 759 KIRCHE HILL DR
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City | CARVER
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State | MN
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Zip | 55315-9302
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Country | US
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Telephone | 952-356-7177
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MN
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