| Lacey Corneliusen, Licsw, Llc | |
|
315 Main St S Ste 301 Minot ND 58701-3956 | |
| (406) 939-1976 | |
| Not Available |
| Full Name | Lacey Corneliusen, Licsw, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 315 Main St S, Minot, North Dakota |
| Authorized Official Name and Position | Lacey Dawn Cornelisen (THERAPIST) |
| Authorized Official Contact | 4069391976 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lacey Corneliusen, Licsw, Llc 1310 2nd St Se Minot ND 58701-5912 Ph: (406) 939-1976 | Lacey Corneliusen, Licsw, Llc 315 Main St S Ste 301 Minot ND 58701-3956 Ph: (406) 939-1976 |
| NPI Number | 1285064246 |
|---|---|
| Provider Enumeration Date | 11/12/2013 |
| Last Update Date | 11/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285064246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 4558 (North Dakota) | Primary |
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