Provider Demographics
NPI:1588434328
Name:FRESHOUR, MAURA SCOUT (LICSW)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:SCOUT
Last Name:FRESHOUR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:MARIE
Other - Last Name:GUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:657 MAIN ST NW STE 104
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1578
Mailing Address - Country:US
Mailing Address - Phone:612-439-3084
Mailing Address - Fax:612-500-4796
Practice Address - Street 1:657 MAIN ST NW STE 104
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1578
Practice Address - Country:US
Practice Address - Phone:612-439-3084
Practice Address - Fax:612-500-4796
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN296081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical