Doctor Name: | KEITH MICHAEL TERHAAR |
NPI Number: | 1598066995 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | LPC00833 |
Business Practice Address: | 6776 Lake Dr 210 Lino Lakes, MN - 550141191 |
Business Phone Number: | 7632457786 |
Business Fax Number: | |
Mailing Address: | 2005 141st Ln Ne, HAM LAKE |
State: | MN |
Postal Code: | 553046841 |
Phone Number: | 7632457786 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2010 |
NPI Last Update Date: | 11/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC00833 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |