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General NPI Number Information
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NPI Number | 1528145281
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Entity Type | Organization
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Legal Business Name | LIFE SKILLS INSTITUTE & CLINIC, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3937 ORCHID LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3281
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Country | US
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Telephone | 763-476-1031
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Fax | 763-476-0181
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Provider Business Mailing Address
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Address Line | 3937 ORCHID LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3281
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Country | US
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Telephone | 763-476-1031
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Fax | 763-476-0181
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Authorized Official
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Title or Position | LICENSEED PSYCHOLOGIST
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Name | DR. MARGARET GREEN
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Credential | EDD, LP
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Telephone | 763-476-1031
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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 | LP0148
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License Number State | MN
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