Provider Demographics
NPI:1407473374
Name:TAUER, MARYLEE MARGARET (BHS, LADC)
Entity Type:Individual
Prefix:
First Name:MARYLEE
Middle Name:MARGARET
Last Name:TAUER
Suffix:
Gender:F
Credentials:BHS, LADC
Other - Prefix:
Other - First Name:MARYLEE
Other - Middle Name:MARGARET
Other - Last Name:STENSLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:366 PRIOR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5165
Mailing Address - Country:US
Mailing Address - Phone:651-529-8908
Mailing Address - Fax:651-646-0196
Practice Address - Street 1:366 PRIOR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5165
Practice Address - Country:US
Practice Address - Phone:651-529-8904
Practice Address - Fax:651-646-0196
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN304164OtherLICENSED ALCOHOL AND DRUG COUNSELOR