Healthcare Provider Details

I. General information

NPI: 1174532279
Provider Name (Legal Business Name): JOHN ARMEN DESTEIAN JD, DPSY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 SAINT CLAIR AVE
SAINT PAUL MN
55105-3214
US

IV. Provider business mailing address

950 SAINT CLAIR AVE
SAINT PAUL MN
55105-3214
US

V. Phone/Fax

Practice location:
  • Phone: 651-293-1684
  • Fax: 651-293-1562
Mailing address:
  • Phone: 651-293-1684
  • Fax: 651-293-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLP0485
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberLP0485
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0485
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberLP0485
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: