| Psychological Healthcare Of Minnesota Pa | |
|
15798 Venture Ln Eden Prairie MN 55344-5729 | |
| (952) 920-2789 | |
| (952) 746-3890 |
| Full Name | Psychological Healthcare Of Minnesota Pa |
|---|---|
| Speciality | Psychologist |
| Location | 15798 Venture Ln, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Douglas Guthrie Frey (PRESIDENT) |
| Authorized Official Contact | 9529202789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Healthcare Of Minnesota Pa 15798 Venture Ln Eden Prairie MN 55344-5729 Ph: (952) 920-2789 | Psychological Healthcare Of Minnesota Pa 15798 Venture Ln Eden Prairie MN 55344-5729 Ph: (952) 920-2789 |
| NPI Number | 1821241340 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 03/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821241340 | NPI | - | NPPES |
| 651353100 | Medicaid | MN | |
| 41B22PS | Other | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP 2224 (Minnesota) | Primary |
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