Individual
TRACY KOTVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, L.P.C.C.
Contact information
Practice address
10535 165TH ST W, LAKEVILLE, MN 55044-5729
(612) 787-2297
Mailing address
10535 165TH ST W, LAKEVILLE, MN 55044-5729
(612) 787-2297
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
01256
MN
101YP2500X
Professional Counselor
Primary
CC00605
MN
Other
Enumeration date
01/26/2013
Last updated
06/10/2013
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