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General NPI Number Information
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NPI Number | 1225635444
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Entity Type | Organization
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Legal Business Name | PSYCHOANALYTIC CONSULTANTS, INC.
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 950 SAINT CLAIR AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3214
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Country | US
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Telephone | 651-293-1684
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Fax | 651-293-1562
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Provider Business Mailing Address
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Address Line | 950 SAINT CLAIR AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3214
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Country | US
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Telephone | 651-293-1684
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN A DESTEIAN
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Credential | DPSY
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Telephone | 651-293-1684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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