Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 103K0000X | MN |
NPI | 1275960049 |
---|---|
Provider Name | Mrs. Lisa Cassman |
First Address | Blaine, MN 55434-4861 |
Second Address | Blaine, MN 55434-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2013 |
Last Update Date | 10/10/2013 |