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General NPI Number Information
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NPI Number | 1124702071
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Entity Type | Organization
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Legal Business Name | OPEN HANDS PSYCHOLOGICAL AND CONSULTING SERVICES
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 4536 58TH AVE N APT 239
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2994
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Country | US
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Telephone | 520-987-3196
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Fax |
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Provider Business Mailing Address
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Address Line | 4536 58TH AVE N APT 239
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2994
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Country | US
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Telephone | 520-987-3196
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ROBIN MARANDA HICKS
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Credential | LPCC
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Telephone | 520-987-3196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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