Healthcare Provider Details

I. General information

NPI: 1790986669
Provider Name (Legal Business Name): DIANNE L. MEIXNER PSYCHOTHERAPY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 KELLOGG BLVD E
SAINT PAUL MN
55101-1411
US

IV. Provider business mailing address

357 KELLOGG BLVD E
SAINT PAUL MN
55101-1411
US

V. Phone/Fax

Practice location:
  • Phone: 651-287-0846
  • Fax:
Mailing address:
  • Phone: 651-287-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4649
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number613
License Number StateMN

VIII. Authorized Official

Name: MS. DIANNE LYNN MEIXNER
Title or Position: PSYCHOTHERAPIST, OWNER
Credential: MA, LICSW, LMFT, ATR
Phone: 651-287-0846