Provider Demographics
NPI:1932817665
Name:CHOUGH, MIMI MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:MARIE
Last Name:CHOUGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-1737
Mailing Address - Country:US
Mailing Address - Phone:719-373-9740
Mailing Address - Fax:
Practice Address - Street 1:108 N MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1730
Practice Address - Country:US
Practice Address - Phone:719-373-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002069106H00000X
MN4377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist