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General NPI Number Information
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NPI Number | 1457825051
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Entity Type | Organization
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Legal Business Name | COXALLAH ENRICHMENT SERVICES, LLC
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 6043 HUDSON RD STE 355
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City | WOODBURY
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State | MN
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Zip | 55125-1017
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Country | US
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Telephone | 651-434-9186
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Fax |
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Provider Business Mailing Address
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Address Line | 6043 HUDSON RD STE 355
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City | WOODBURY
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State | MN
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Zip | 55125-1017
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Country | US
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Telephone | 651-434-9186
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. DASHERLINE COX JOHNSON
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Credential |
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Telephone | 651-434-9186
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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 |
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License Number State |
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