| Doctor Name: | RALPH BERRY |
| NPI Number: | 1043569049 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC |
| License Number: | 303336 |
| Business Practice Address: | 15 Washington St Ste 4 Brainerd, MN - 564013351 |
| Business Phone Number: | 6124542451 |
| Business Fax Number: | |
| Mailing Address: | 4633 Forest Hills Cir, NISSWA |
| State: | MN |
| Postal Code: | 564682369 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2012 |
| NPI Last Update Date: | 09/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 303336 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |