Provider Demographics
NPI:1861673840
Name:BELLOWS, MARK KEVIN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEVIN
Last Name:BELLOWS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16349 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7704
Mailing Address - Country:US
Mailing Address - Phone:952-451-9503
Mailing Address - Fax:
Practice Address - Street 1:9623 162ND ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7704
Practice Address - Country:US
Practice Address - Phone:952-898-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist