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General NPI Number Information
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NPI Number | 1053719732
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Entity Type | Organization
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Legal Business Name | NOVO PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 720 VIKING DR E
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City | MAPLEWOOD
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State | MN
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Zip | 55117-1666
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Country | US
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Telephone | 612-710-9297
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Fax |
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Provider Business Mailing Address
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Address Line | 720 VIKING DR E
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City | MAPLEWOOD
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State | MN
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Zip | 55117-1666
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST, PRESIDENT & CEO
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Name | PAUL NOVOTNY
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Credential | PSYD, LP, LPCC
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Telephone | 612-710-9297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP5731
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License Number State | MN
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