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5009 Excelsior Blvd Suite 134 St. Louis Park MN 55416 | |
(612) 360-5685 | |
(952) 285-4103 |
Full Name | |
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Speciality | Psychologist - Cognitive & Behavioral |
Location | 5009 Excelsior Blvd, St. Louis Park, Minnesota |
Authorized Official Name and Position | Joshua M Kent (LICSW) |
Authorized Official Contact | 6512640260 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5009 Excelsior Blvd Suite 134 St. Louis Park MN 55416 Ph: (612) 360-5685 | 5009 Excelsior Blvd Suite 134 St. Louis Park MN 55416 Ph: (612) 360-5685 |
NPI Number | 1629108410 |
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Provider Enumeration Date | 03/07/2007 |
Last Update Date | 08/28/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629108410 | NPI | - | NPPES |
607649100 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TB0200X | Psychologist - Cognitive & Behavioral | 15118 (Minnesota) | Primary |
2084P0800X | Psychiatry & Neurology - Psychiatry | 15118 (Minnesota) | Secondary |