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General NPI Number Information
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NPI Number | 1477859437
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Entity Type | Organization
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Legal Business Name | SOUTH SUBURBAN PSYCHOLOGICAL & COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 4635 NICOLS RD SUITE 200
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City | EAGAN
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State | MN
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Zip | 55122-3337
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Country | US
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Telephone | 952-431-6862
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Fax |
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Provider Business Mailing Address
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Address Line | 4635 NICOLS RD SUITE 200
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City | EAGAN
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State | MN
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Zip | 55122-3337
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Country | US
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Telephone | 952-431-6862
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | MICHAEL JAMES FERRARESE
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Credential | PH.D., L.P.
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Telephone | 952-431-6862
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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 |
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License Number State |
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