Individual
MARY ANN HAVSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. LICSW
Contact information
Practice address
9001 E BLGTN FRWY, SUITE 140, BLOOMINGTON, MN 55420
(612) 518-5105
(952) 881-3588
Mailing address
3703 TOWNDALE DR, BLOOMINGTON, MN 55431-1047
(612) 518-5105
(952) 881-3588
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8300
MN
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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