Healthcare Provider Details

I. General information

NPI: 1902437627
Provider Name (Legal Business Name): JOHN ROBERT NORD MA-PSYCHOTHERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN ROBERT NORD JOHN R NORD

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 WAYZATA BLVD STE 101
MINNETONKA MN
55305-1507
US

IV. Provider business mailing address

939 HUNTINGTON WAY
JORDAN MN
55352-4531
US

V. Phone/Fax

Practice location:
  • Phone: 612-790-6673
  • Fax: 952-582-1666
Mailing address:
  • Phone: 612-790-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: