Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003122490 |
---|---|
Provider Name | Nelson Perez |
First Address | Minneapolis, MN 55407-1547 |
Second Address | Minneapolis, MN 55407-1547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2010 |
Last Update Date | 24/08/2010 |