Healthcare Provider Details

I. General information

NPI: 1013840982
Provider Name (Legal Business Name): MINNESOTA PSYCHOANALYTIC COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 PORTLAND AVE
MINNEAPOLIS MN
55407-1020
US

IV. Provider business mailing address

2709 PORTLAND AVE
MINNEAPOLIS MN
55407-1020
US

V. Phone/Fax

Practice location:
  • Phone: 320-290-7330
  • Fax: 320-290-7330
Mailing address:
  • Phone: 320-290-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL LEHMAN CONWAY
Title or Position: MEMBER
Credential: MS LPCC
Phone: 320-290-7330