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General NPI Number Information
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NPI Number | 1366626095
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Entity Type | Organization
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Legal Business Name | AMV PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 7200 FRANCE AVE S SUITE #224
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City | EDINA
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State | MN
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Zip | 55435-4300
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Country | US
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Telephone | 612-636-7915
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Fax | 952-831-0443
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Provider Business Mailing Address
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Address Line | 5916 COLFAX AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-2104
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Country | US
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Telephone | 612-636-7915
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Fax | 952-831-0443
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ANDREA M VICTOR
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Credential | PH.D., LP
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Telephone | 612-636-7915
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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 | 4735
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 4735
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License Number State | MN
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