Organization
HALBUR/WITHAM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANNETTE C. WITHAM LMFT (CLINICAL SUPERVISOR)
(320) 282-0112
Entity
Organization
Contact information
Practice address
2623 125TH ST NE, RICE, MN 56367-9746
(320) 260-6755
Mailing address
65189 365TH ST, WATKINS, MN 55389-6054
(320) 224-1407
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
106H00000X
MN
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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