| Philip Psychological Clinic | |
|
510 Sibley Street Suite 200 Mankato MN 56001 | |
| (207) 345-5049 | |
| (507) 345-5049 |
| Full Name | Philip Psychological Clinic |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 510 Sibley Street, Mankato, Minnesota |
| Authorized Official Name and Position | Ponvelil Philipose Philip (OWNER DIRECTOR) |
| Authorized Official Contact | 5073455049 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Philip Psychological Clinic 510 Sibley Street Suite 200 Mankato MN 56001 Ph: (207) 345-5049 | Philip Psychological Clinic 510 Sibley Street Suite 200 Mankato MN 56001 Ph: (207) 345-5049 |
| NPI Number | 1326216169 |
|---|---|
| Provider Enumeration Date | 02/14/2008 |
| Last Update Date | 02/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326216169 | NPI | - | NPPES |
| 41516PH | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP2258 (Minnesota) | Primary |
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