Individual
MACUSHLA COLLEEN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4895 EDGEWATER DR, MOUND, MN 55364-2005
(612) 308-4309
Mailing address
4895 EDGEWATER DR, MOUND, MN 55364-2005
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC00446
MN
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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