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General NPI Number Information
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NPI Number | 1801117643
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Entity Type | Organization
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Legal Business Name | MARY ANDERS
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 13911 RIDGEDALE DR SUITE 330
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City | MINNETONKA
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State | MN
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Zip | 55305-1771
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Country | US
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Telephone | 763-447-5793
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Fax |
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Provider Business Mailing Address
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Address Line | 13911 RIDGEDALE DR SUITE 330
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City | MINNETONKA
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State | MN
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Zip | 55305-1771
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Country | US
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Telephone | 763-447-5793
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY ANDERS
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Credential | MA LP
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Telephone | 763-447-5793
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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 | LP3976
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License Number State | MN
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