Healthcare Provider Details

I. General information

NPI: 1215258140
Provider Name (Legal Business Name): CAIRNS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16204 HIGHWAY 7
MINNETONKA MN
55345-3405
US

IV. Provider business mailing address

16204 HIGHWAY 7
MINNETONKA MN
55345-3405
US

V. Phone/Fax

Practice location:
  • Phone: 952-934-2555
  • Fax: 952-934-3010
Mailing address:
  • Phone: 952-934-2555
  • Fax: 952-934-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLP 3332
License Number StateMN

VIII. Authorized Official

Name: MOLLY DEPREKEL
Title or Position: CLINICAL DIRECTOR
Credential: LP
Phone: 952-934-2555