Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP2333 | MN |
NPI | 1013092444 |
---|---|
Provider Name | Dr. Ray Martin Conroe |
First Address | Arden Hills, MN 55112-3630 |
Second Address | Minneapolis, MN 55417-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |