Individual
KYLIE LOUISE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2443 MAMIE AVE E, MAPLEWOOD, MN 55119-5906
(651) 246-1033
Mailing address
2443 MAMIE AVE E, MAPLEWOOD, MN 55119-5906
(651) 246-1033
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
20040
MN
Other
Enumeration date
12/23/2018
Last updated
12/23/2018
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