Healthcare Provider Details

I. General information

NPI: 1710354345
Provider Name (Legal Business Name): DAVID NATHAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 GRAND AVE STE 203
SAINT PAUL MN
55105-3014
US

IV. Provider business mailing address

944 GRAND AVE STE 203
SAINT PAUL MN
55105-3014
US

V. Phone/Fax

Practice location:
  • Phone: 651-337-3944
  • Fax: 651-666-1526
Mailing address:
  • Phone: 651-337-3944
  • Fax: 651-666-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP6068
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: