Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1919 | MN |
NPI | 1003048430 |
---|---|
Provider Name | Troy Robert Weber-Brown |
First Address | Saint Cloud, MN 56303-5000 |
Second Address | Saint Cloud, MN 56303-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2009 |
Last Update Date | 09/08/2017 |