| Northland Therapy Center | |
|
2324 University Ave W, Ste 100 St Paul MN 55114-1854 | |
| (651) 641-1009 | |
| (651) 789-5677 |
| Full Name | Northland Therapy Center |
|---|---|
| Speciality | Psychologist |
| Location | 2324 University Ave W, Ste 100, St Paul, Minnesota |
| Authorized Official Name and Position | James Wagner (THERAPIST/PARTNER) |
| Authorized Official Contact | 6516411009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northland Therapy Center 2324 University Ave W, Ste 100 St Paul MN 55114-1854 Ph: (651) 641-1009 | Northland Therapy Center 2324 University Ave W, Ste 100 St Paul MN 55114-1854 Ph: (651) 641-1009 |
| NPI Number | 1568585420 |
|---|---|
| Provider Enumeration Date | 04/07/2007 |
| Last Update Date | 03/24/2023 |
| Certification Date | 03/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568585420 | NPI | - | NPPES |
| 876248100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP 3528 (Minnesota) | Primary |
| 103T00000X | Psychologist | LP 2149 (Minnesota) | Secondary |
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