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NPI Code Detail

MEDICARE: MOLLY DIRKS MHPR

MEDICARE: MOLLY DIRKS MHPR
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1861107096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY DIRKS MHPR
Provider Business Mailing Address
First Line : 2102 W SUPERIOR ST APT 305
Second Line :
City : DULUTH
State : MN
Zip : 55806-2013
Country : US
Telephone Number : 218-232-3509
Fax Number :
Provider Business Practice Location Address
First Line : 4720 BURNING TREE RD
Second Line :
City : DULUTH
State : MN
Zip : 55811-2634
Country : US
Telephone Number : 218-623-1800
Fax Number : 218-623-1811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2023
Last Update Date : 01/24/2023

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