Organization
CROWN IMPERIAL PRESS, LLC
Active
Other names
Steven R. Wiese, M.S., M.Div, Licensed Psychologist
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN ROGER WIESE M.S., M.DIV., LP (DIRECTOR)
(651) 785-3920
Entity
Organization
Contact information
Practice address
1935 COUNTY ROAD B2 W, SUITE #102, SAINT PAUL, MN 55113-2729
(651) 785-3920
Mailing address
21211 IMPERIAL AVE N, FOREST LAKE, MN 55025-9547
(651) 785-3920
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LP 1426
MN
Other
Enumeration date
08/29/2013
Last updated
08/29/2013
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