| Southern Minnesota Psychological Services, Pllc | |
|
329 N Main St Ste 104l Austin MN 55912-3478 | |
| (507) 434-1092 | |
| Not Available |
| Full Name | Southern Minnesota Psychological Services, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 329 N Main St Ste 104l, Austin, Minnesota |
| Authorized Official Name and Position | Timothy Patrick Lang (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5074341092 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Minnesota Psychological Services, Pllc 2701 9th Ave Sw Austin MN 55912-5406 Ph: (507) 438-3062 | Southern Minnesota Psychological Services, Pllc 329 N Main St Ste 104l Austin MN 55912-3478 Ph: (507) 434-1092 |
| NPI Number | 1720635519 |
|---|---|
| Provider Enumeration Date | 08/26/2019 |
| Last Update Date | 07/19/2023 |
| Certification Date | 07/19/2023 |
| Medicare PECOS PAC ID | 4284964727 |
|---|---|
| Medicare Enrollment ID | O20190925002450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720635519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Timothy P Lang |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205813037 PECOS PAC ID: 4981732120 Enrollment ID: I20100510000586 |
| Provider Name | Daryl Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871018192 PECOS PAC ID: 5092088872 Enrollment ID: I20170829004206 |
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