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General NPI Number Information
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NPI Number | 1861673840
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Entity Type | Individual
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Provider Name | MARK KEVIN BELLOWS LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 9623 162ND ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-7704
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Country | US
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Telephone | 952-898-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 16349 GREENBRIAR CT
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City | LAKEVILLE
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State | MN
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Zip | 55044-7704
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Country | US
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Telephone | 952-451-9503
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1591
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License Number State | MN
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