| Doctor Name: | MARY LOU HONSTEAD |
| NPI Number: | 1033401542 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D., L.P. |
| License Number: | LP0816 |
| Business Practice Address: | 516 Mission House Ln New Brighton, MN - 551122571 |
| Business Phone Number: | 6516365120 |
| Business Fax Number: | 6516365124 |
| Mailing Address: | 516 Mission House Ln, NEW BRIGHTON |
| State: | MN |
| Postal Code: | 551122571 |
| Phone Number: | 6516365120 |
| Fax Number: | 6516365124 |
| NPI Enumeration Date: | 05/03/2011 |
| NPI Last Update Date: | 05/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | LP0816 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |