Organization
PROFOUND THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE J OTIS LMFT (OWNER - MARRIAGE & FAMILY THERAPIST)
(320) 266-1693
Entity
Organization
Contact information
Practice address
720 8TH AVE N, SAINT CLOUD, MN 56303-3420
(320) 266-1693
(320) 251-0217
Mailing address
720 8TH AVE N, SAINT CLOUD, MN 56303-3420
(320) 266-1693
(320) 251-0217
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
07/07/2012
Last updated
01/13/2014
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