| Psychological&behavioralconsultantspa | |
|
2186 3rd St Suite 105 White Bear Lake MN 55110-3263 | |
| (651) 227-8880 | |
| (651) 227-8908 |
| Full Name | Psychological&behavioralconsultantspa |
|---|---|
| Speciality | Psychologist |
| Location | 2186 3rd St, White Bear Lake, Minnesota |
| Authorized Official Name and Position | W S Balcerzak (CEO) |
| Authorized Official Contact | 6512278880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological&behavioralconsultantspa 2186 3rd St Suite 105 White Bear Lake MN 55110-3263 Ph: (651) 227-8880 | Psychological&behavioralconsultantspa 2186 3rd St Suite 105 White Bear Lake MN 55110-3263 Ph: (651) 227-8880 |
| NPI Number | 1811026123 |
|---|---|
| Provider Enumeration Date | 03/04/2007 |
| Last Update Date | 02/24/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811026123 | NPI | - | NPPES |
| 998518200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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