Healthcare Provider Details

I. General information

NPI: 1982180758
Provider Name (Legal Business Name): HUGHES-SCALISE PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 RAYMOND AVE STE 440
SAINT PAUL MN
55114-1525
US

IV. Provider business mailing address

4013 DEERWOOD TRL
EAGAN MN
55122-1885
US

V. Phone/Fax

Practice location:
  • Phone: 612-584-1643
  • Fax:
Mailing address:
  • Phone: 651-233-3608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIGAIL TIMM HUGHES-SCALISE
Title or Position: PEDIATRIC PSYCHOLOGIST
Credential: PHD, LP
Phone: 651-584-1643