Individual
MR. ANTONY STATELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, LP
Contact information
Practice address
1213 E FRANKLIN AVE, MINNEAPOLIS, MN 55404
(612) 872-8086
Mailing address
1213 E FRANKLIN AVE, MINNEAPOLIS, MN 55404-2923
(612) 872-8086
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LP5258
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP5258
MN LIC
MN
Enumeration date
06/17/2011
Last updated
08/09/2018
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