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General NPI Number Information
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NPI Number | 1013840982
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Entity Type | Organization
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Legal Business Name | MINNESOTA PSYCHOANALYTIC COLLECTIVE
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 2709 PORTLAND AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1020
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Country | US
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Telephone | 320-290-7330
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Fax | 320-290-7330
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Provider Business Mailing Address
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Address Line | 2709 PORTLAND AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1020
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Country | US
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Telephone | 320-290-7330
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SAMUEL LEHMAN CONWAY
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Credential | MS LPCC
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Telephone | 320-290-7330
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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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