Individual
MARY LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
329 FARIBAULT RD, FARIBAULT, MN 55021-5780
(507) 334-1983
(507) 333-2307
Mailing address
329 FARIBAULT RD, FARIBAULT, MN 55021-5780
(507) 334-1983
(507) 333-2307
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14947
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14947
LICENSE NUMBER
MN
Enumeration date
09/21/2006
Last updated
07/08/2007
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