Individual
JEROME RAYMOND BOTTELBERGHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
110 E 2ND ST, MINNEOTA, MN 56264-9639
(507) 530-2029
Mailing address
110 E 2ND ST, MINNEOTA, MN 56264-9639
(507) 530-2029
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01219
MN
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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