Provider Demographics
NPI:1740370402
Name:SKRIEN, MARK W (MA, LP, LMFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:SKRIEN
Suffix:
Gender:M
Credentials:MA, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4704
Practice Address - Country:US
Practice Address - Phone:507-451-2630
Practice Address - Fax:507-455-8133
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1295103T00000X
MN196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-20365OtherUNITED BEHAVIORAL HEALTH
MN57443SKOtherBLUE CROSS BLUE SHIELD
MNHP18250OtherHEALTH PARTNERS
MN117883OtherUCARE