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General NPI Number Information
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NPI Number | 1275175242
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Entity Type | Organization
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Legal Business Name | NAMU INTEGRATIVE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 1145 GRAND AVE # 101
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City | SAINT PAUL
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State | MN
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Zip | 55105-2629
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Country | US
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Telephone | 612-594-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 GRAND AVE # 101
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City | SAINT PAUL
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State | MN
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Zip | 55105-2629
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Country | US
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Telephone | 612-424-0051
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | HYE-KYONG KIM
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Credential | PSYD, LP, SEP
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Telephone | 612-424-0051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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