| Pathways Psychology On Grand, Pllc | |
|
1053 Grand Ave Suite 116 Saint Paul MN 55105-3022 | |
| (651) 287-0931 | |
| (651) 287-0967 |
| Full Name | Pathways Psychology On Grand, Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1053 Grand Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Jill R Leblond (HIPAA OFFICER) |
| Authorized Official Contact | 6512870931 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways Psychology On Grand, Pllc 1053 Grand Ave Suite 116 Saint Paul MN 55105-3022 Ph: (651) 287-0931 | Pathways Psychology On Grand, Pllc 1053 Grand Ave Suite 116 Saint Paul MN 55105-3022 Ph: (651) 287-0931 |
| NPI Number | 1649281676 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 11/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649281676 | NPI | - | NPPES |
| 626K2PA | Other | MN | BLUE CROSS BLUE SHIELD ID |
| 9374051000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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