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General NPI Number Information
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NPI Number | 1407907397
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Entity Type | Organization
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Legal Business Name | SIMONSON PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10267 UNIVERSITY AVE #203
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City | BLAINE
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State | MN
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Zip | 55434
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Country | US
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Telephone | 763-639-7462
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Fax | 763-786-5462
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Provider Business Mailing Address
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Address Line | 10267 UNIVERSITY AVE NE SUITE 203
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City | BLAINE
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State | MN
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Zip | 55434
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Country | US
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Telephone | 763-639-7462
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Fax | 763-786-5462
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Authorized Official
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Title or Position | PRESIDENT PSYCHOLOGIST
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Name | MR. DANIEL PAUL SIMONSON
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Credential | MS LP
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Telephone | 763-639-7462
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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 | 3450
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License Number State | MN
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