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General NPI Number Information
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NPI Number | 1326242702
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Entity Type | Organization
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Legal Business Name | CENTER FOR PSYCHOLOGICAL AND EDUCATIONAL ASSESSMENT
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 290 CENTENNIAL DR STOP 7108 210 MONTGOMERY HALL
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City | GRAND FORKS
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State | ND
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Zip | 58202-6063
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Country | US
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Telephone | 701-777-3260
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Fax | 701-777-3454
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Provider Business Mailing Address
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Address Line | 290 CENTENNIAL DR STOP 7108 210 MONTGOMERY HALL
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City | GRAND FORKS
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State | ND
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Zip | 58202-6063
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Country | US
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Telephone | 701-777-3260
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Fax | 701-777-3454
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Authorized Official
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Title or Position | PROFESSOR OF PSYCHOLOGY
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Name | DR. THOMAS VICTOR PETROS
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Credential | PH.D.
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Telephone | 701-777-3260
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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 | 231
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License Number State | ND
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