Individual
MARK TERESA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
681 17TH AVE NE, SUITE 312, MINNEAPOLIS, MN 55413-4590
(612) 876-5917
Mailing address
681 17TH AVE NE, SUITE 312, MINNEAPOLIS, MN 55413-4590
(612) 876-5917
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2584
MN
Other
Enumeration date
10/11/2013
Last updated
10/11/2013
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