Individual
MARK THEODORE ORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
16809 260TH AVE, MC GRATH, MN 56350-4538
(320) 676-1757
Mailing address
16809 260TH AVE, MC GRATH, MN 56350-4538
(320) 676-1757
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4963
MN
Other
Enumeration date
10/10/2008
Last updated
10/10/2008
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