Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP4162 | MN |
NPI | 1003809856 |
---|---|
Provider Name | Christian L Babo |
First Address | Golden Valley, MN 55427-4562 |
Second Address | Golden Valley, MN 55427-4562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 08/07/2007 |