Healthcare Provider Details

I. General information

NPI: 1417941063
Provider Name (Legal Business Name): CENTER FOR PSYCHOLOGICAL SERVICES FOR TWIN CITIES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 RUTH ST N
SAINT PAUL MN
55119-4323
US

IV. Provider business mailing address

245 RUTH ST N
SAINT PAUL MN
55119-4323
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-4841
  • Fax: 651-735-8359
Mailing address:
  • Phone: 651-735-4841
  • Fax: 651-735-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MADALINE G. BARNES
Title or Position: CFO
Credential: PH.D.
Phone: 651-735-4841