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General NPI Number Information
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NPI Number | 1508500455
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Entity Type | Organization
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Legal Business Name | BROOKVIEW PSYCHOLOGY & CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 2136 FORD PKWY # 5108
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City | SAINT PAUL
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State | MN
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Zip | 55116-2850
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Country | US
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Telephone | 651-964-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 2136 FORD PKWY # 5108
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City | SAINT PAUL
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State | MN
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Zip | 55116-2850
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Country | US
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Telephone | 651-432-0400
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Fax | 651-432-0420
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Authorized Official
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Title or Position | CEO
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Name | DR. THOMAS NGUYEN
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Credential | PSYD, LP
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Telephone | 561-432-0400
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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 |
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License Number State |
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Taxonomy #2
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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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