Healthcare Provider Details

I. General information

NPI: 1760556245
Provider Name (Legal Business Name): CHRISTOPHER B MERTZ PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 PHALEN BLVD
SAINT PAUL MN
55130-2400
US

IV. Provider business mailing address

3366 OAKDALE AVE N
ROBBINSDALE MN
55422-2948
US

V. Phone/Fax

Practice location:
  • Phone: 651-495-6200
  • Fax:
Mailing address:
  • Phone: 763-581-6400
  • Fax: 763-581-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP4899
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4899
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: