| Watershed Psychological Services | |
|
4255 Pheasant Ridge Drive Suite 412 Blaine MN 55391 | |
| (763) 317-6222 | |
| (763) 307-3835 |
| Full Name | Watershed Psychological Services |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4255 Pheasant Ridge Drive, Blaine, Minnesota |
| Authorized Official Name and Position | Megan Jean Boom Shedlock (CO-OWNER) |
| Authorized Official Contact | 3202664535 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Watershed Psychological Services 4255 Pheasant Ridge Dr Ne Suite 412 Blaine MN 55449-4537 Ph: (763) 317-6222 | Watershed Psychological Services 4255 Pheasant Ridge Drive Suite 412 Blaine MN 55391 Ph: (763) 317-6222 |
| NPI Number | 1952763351 |
|---|---|
| Provider Enumeration Date | 03/24/2016 |
| Last Update Date | 08/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952763351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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