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General NPI Number Information
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NPI Number | 1164610598
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Entity Type | Organization
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Legal Business Name | GARY P. LIABOE, PHD, LP, LLC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 3820 CLEVELAND AVE N ST 400
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City | ARDEN HILLS
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State | MN
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Zip | 55112-3285
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Country | US
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Telephone | 651-389-4400
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Fax | 651-389-4410
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Provider Business Mailing Address
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Address Line | 3820 CLEVELAND AVE N ST 400
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City | ARDEN HILLS
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State | MN
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Zip | 55112-3285
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Country | US
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Telephone | 651-389-4400
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Fax | 651-389-4410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY P LIABOE
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Credential | PH.D., LP
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Telephone | 651-389-4400
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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 | LP0737
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License Number State | MN
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