| Center For Psychological Consultation, P.a. | |
|
8085 Wayzata Blvd Suite 100b Golden Valley MN 55426-1453 | |
| (612) 719-0856 | |
| (651) 484-8551 |
| Full Name | Center For Psychological Consultation, P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 8085 Wayzata Blvd, Golden Valley, Minnesota |
| Authorized Official Name and Position | James Edward Boscardin (PRESIDENT) |
| Authorized Official Contact | 6127190856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Psychological Consultation, P.a. 1092 Lawnview Ave Shoreview MN 55126-8408 Ph: (612) 719-0856 | Center For Psychological Consultation, P.a. 8085 Wayzata Blvd Suite 100b Golden Valley MN 55426-1453 Ph: (612) 719-0856 |
| NPI Number | 1407123425 |
|---|---|
| Provider Enumeration Date | 11/18/2011 |
| Last Update Date | 11/18/2011 |
| Medicare PECOS PAC ID | 8921268392 |
|---|---|
| Medicare Enrollment ID | O20120321000636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407123425 | NPI | - | NPPES |
| 710552500 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP0709 (Minnesota) | Primary |
| Provider Name | James E Boscardin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972682847 PECOS PAC ID: 1254591639 Enrollment ID: I20120321000697 |
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