Doctor Name: | CARMELITA REGINA PRIVATT |
NPI Number: | 1124376611 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC |
License Number: | |
Business Practice Address: | 1125 6th St Se Willmar, MN - 562014675 |
Business Phone Number: | 3202354613 |
Business Fax Number: | |
Mailing Address: | 1125 6th St Se, WILLMAR |
State: | MN |
Postal Code: | 562014675 |
Phone Number: | 3202354613 |
Fax Number: | |
NPI Enumeration Date: | 08/15/2012 |
NPI Last Update Date: | 01/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |