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General NPI Number Information
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NPI Number | 1316910383
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Entity Type | Organization
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Legal Business Name | GURGANUS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 7241 OHMS LANE SUITE 145
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City | EDINA
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State | MN
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Zip | 55439-2136
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Country | US
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Telephone | 952-920-0711
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Fax | 952-920-0716
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Provider Business Mailing Address
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Address Line | 7241 OHMS LANE SUITE 145
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City | EDINA
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State | MN
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Zip | 55439-2136
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Country | US
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Telephone | 952-920-0711
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Fax | 952-920-0716
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA LEA GURGANUS
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Credential | PSY.D., L.P.
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Telephone | 952-920-0711
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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 | LP4536
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License Number State | MN
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