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General NPI Number Information
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NPI Number | 1255431243
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Entity Type | Individual
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Provider Name | JAMES S ANTHONY PHD, LP
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4444 CENTERVILLE ROAD #235
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55127-3712
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Country | US
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Telephone | 651-289-3111
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Fax | 651-426-6766
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Provider Business Mailing Address
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Address Line | 4444 CENTERVILLE ROAD #235
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55127-3712
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Country | US
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Telephone | 651-289-3111
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Fax | 651-289-3113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LP1905
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License Number State | MN
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