Individual
RALPH BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
15 WASHINGTON ST STE 4, BRAINERD, MN 56401-3351
(612) 454-2451
Mailing address
4633 FOREST HILLS CIR, NISSWA, MN 56468-2369
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303336
MN
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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