Individual
KRISTINE A DOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPCC
Contact information
Practice address
11292 86TH AVE N STE 106, MAPLE GROVE, MN 55369-4510
(952) 300-5908
Mailing address
11292 86TH AVE N STE 106, MAPLE GROVE, MN 55369-4510
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
01687
MN
101YM0800X
Mental Health Counselor
Primary
CC01429
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
637688900
—
MN
Enumeration date
12/11/2014
Last updated
06/21/2017
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