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General NPI Number Information
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NPI Number | 1003195942
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Entity Type | Organization
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Legal Business Name | PLYMOUTH PSYCH GROUP, LLC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 3021 HARBOR LN N SUITE 206
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City | PLYMOUTH
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State | MN
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Zip | 55447-5109
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Country | US
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Telephone | 651-271-9005
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Fax | 763-271-2707
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Provider Business Mailing Address
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Address Line | 3021 HARBOR LN N SUITE 206
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City | PLYMOUTH
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State | MN
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Zip | 55447-5109
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Country | US
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Telephone | 651-271-9005
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Fax | 763-271-2707
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Authorized Official
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Title or Position | OWNER
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Name | ISRAEL SOKEYE
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Credential | MD
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Telephone | 651-271-9005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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