Individual
MR. GEORGE LORNE TETREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
823 MAPLE ST, BRAINERD, MN 56401-3770
(833) 316-0698
Mailing address
823 MAPLE ST, BRAINERD, MN 56401-3770
(833) 316-0698
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2766
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013904051
—
MN
Enumeration date
09/11/2006
Last updated
11/08/2022
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