Healthcare Provider Details

I. General information

NPI: 1356260434
Provider Name (Legal Business Name): ROBERT MCCAULEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 WYCLIFF ST
SAINT PAUL MN
55114-1272
US

IV. Provider business mailing address

7320 JACKSON ST NE
FRIDLEY MN
55432-3207
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-7294
  • Fax:
Mailing address:
  • Phone: 309-825-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MCCAULEY
Title or Position: OWNER / PSYCHOTHERAPIST
Credential: LICSW CST MSW MED
Phone: 309-825-0538