Healthcare Provider Details

I. General information

NPI: 1457304941
Provider Name (Legal Business Name): BEHAVIORAL PSYCHOLOGICAL CONSULTANTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 REED ST SUITE 115
MANKATO MN
56001-6410
US

IV. Provider business mailing address

600 REED ST SUITE 115
MANKATO MN
56001-6410
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-4060
  • Fax: 507-625-3915
Mailing address:
  • Phone: 507-625-4060
  • Fax: 507-625-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00036
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP2831
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3385
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116378
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39584
License Number StateMN

VIII. Authorized Official

Name: DR. KATHLEEN CHRISTENSEN
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: PSYD
Phone: 507-625-4060