Individual
BRANDON STAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1321 13TH ST N, SAINT CLOUD, MN 56303-2613
(320) 202-2060
Mailing address
1321 13TH ST N, SAINT CLOUD, MN 56303-2613
(320) 202-2060
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC02196
MN
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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