Individual
MS. MOLLY S BLACKMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
8085 WAYZATA BLVD, SUITE 101, GOLDEN VALLEY, MN 55426-1453
(651) 769-6300
(651) 769-6349
Mailing address
8085 WAYZATA BLVD, SUITE 101, GOLDEN VALLEY, MN 55426-1453
(651) 769-6300
(651) 769-6349
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1056
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323684600
—
MN
Enumeration date
12/28/2005
Last updated
10/22/2009
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