Doctor Name: | KRISTIN L TEBOW |
NPI Number: | 1275806887 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | 00438 |
Business Practice Address: | 110 14th Ave E Sartell, MN - 563774644 |
Business Phone Number: | 3202021400 |
Business Fax Number: | 3202028662 |
Mailing Address: | 617 Oak St, BRAINERD |
State: | MN |
Postal Code: | 564013610 |
Phone Number: | 2188297140 |
Fax Number: | 2188297124 |
NPI Enumeration Date: | 02/13/2012 |
NPI Last Update Date: | 02/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 00438 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |