Mark Richard Amundsen, DMin
Counselor, Professional in Glendale, WI. Individual provider (NPI-1).
NPI number1053404665
StatusActive
Last updated in NPPESJul 14, 2022
Details
- NPI
- 1053404665
- Entity type
- Individual (NPI-1)
- Name
- Mark Richard Amundsen
- Credential
- DMin
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 2, 2006
- Certification date
- Jul 1, 2022
- Last updated
- Jul 14, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 4127-125 | WI | Yes |
| 106H00000X | Marriage & Family Therapist | LH00009180 | WA |
Practice location
5650 N Greenbay AveGlendale, WI 53209
Phone 262-789-1191
Mailing address
5650 N Greenbay AveGlendale, WI 53209
Phone 262-789-1191
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