Organization
LACEY CORNELIUSEN, LICSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LACEY DAWN CORNELISEN LICSW (THERAPIST)
(406) 939-1976
Entity
Organization
Contact information
Practice address
315 MAIN ST S, STE 301, MINOT, ND 58701-3956
(406) 939-1976
Mailing address
1310 2ND ST SE, MINOT, ND 58701-5912
(406) 939-1976
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4558
ND
Other
Enumeration date
11/12/2013
Last updated
11/12/2013
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