Individual
JOLLIEN TUSHABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7010 HIGHWAY 7, ST LOUIS PARK, MN 55426-4223
(612) 889-0278
Mailing address
7010 MN-7,, ST. LOUIS PARK,, MN 55426-1809
(952) 814-0207
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181205001452
NON
—
Enumeration date
12/06/2018
Last updated
08/20/2019
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