Healthcare Provider Details

I. General information

NPI: 1649193814
Provider Name (Legal Business Name): SOUTHMPLSPSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 GRAND AVE S
MINNEAPOLIS MN
55409-1913
US

IV. Provider business mailing address

202 N CEDAR AVE STE 1
OWATONNA MN
55060-2306
US

V. Phone/Fax

Practice location:
  • Phone: 928-566-8482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: EMILY WILSON JAMES
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 928-566-8482