Provider Demographics
NPI:1942979216
Name:KOR, MICHAELA MARIE (LPCC, ATR)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:KOR
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E RIVER RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-5407
Mailing Address - Country:US
Mailing Address - Phone:507-258-3287
Mailing Address - Fax:
Practice Address - Street 1:3520 E RIVER RD NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-5407
Practice Address - Country:US
Practice Address - Phone:507-258-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010477101YP2500X
MNCC02996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty