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NPI Code Detail

MEDICARE: MRS. MARY W DROULLARD MA, LP, LMFT

MEDICARE: MRS. MARY W DROULLARD MA, LP, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist1513MN
2103TC1900XCounseling Psychologist5308MN

General Provider Information

NPI Number : 1710003843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY W DROULLARD MA, LP, LMFT
Provider Business Mailing Address
First Line : 3499 LEXINGTON AVE N STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55126-7058
Country : US
Telephone Number : 651-486-4828
Fax Number : 651-482-9119
Provider Business Practice Location Address
First Line : 3499 LEXINGTON AVE N STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55126-7058
Country : US
Telephone Number : 651-486-4828
Fax Number : 651-482-9119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 08/27/2012

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