Individual
JAIME-LYNN MALLORY LAGRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED, LPCC
Contact information
Practice address
40 11TH ST, CLOQUET, MN 55720-1817
(218) 879-4559
(218) 879-0282
Mailing address
1401 EAST 1ST STREET, DULUTH, MN 55805
(218) 728-4491
(218) 302-8698
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1274
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568918126
—
MN
05
—
1568918126
—
WI
Enumeration date
09/01/2016
Last updated
09/23/2021
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