Provider Demographics
NPI:1043036478
Name:HESSE, MALLORIE (MS, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:MALLORIE
Middle Name:
Last Name:HESSE
Suffix:
Gender:F
Credentials:MS, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1177
Mailing Address - Country:US
Mailing Address - Phone:320-202-2037
Mailing Address - Fax:320-281-3554
Practice Address - Street 1:1321 13TH ST N BLDG A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2613
Practice Address - Country:US
Practice Address - Phone:320-252-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health