Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | #302151 | |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 302151 | MN |
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP1600X | Pastoral Counselor | WI | |
N | 101YP2500X | Professional Counselor | ||
N | 101YP2500X | Professional Counselor | #1763 LMFT | MN |
NPI | 1043376635 |
---|---|
Provider Name | Benedict A Walz |
First Address | Saint Cloud, MN 56301-4515 |
Second Address | Saint Cloud, MN 56301-4515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 17/03/2010 |