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General NPI Number Information
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NPI Number | 1659594372
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Entity Type | Organization
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Legal Business Name | JIM HORGAN MA, LP
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 S 5TH ST SUITE 400
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City | MARSHALL
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State | MN
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Zip | 56258-1240
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Country | US
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Telephone | 507-929-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S 5TH ST SUITE 400
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City | MARSHALL
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State | MN
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Zip | 56258-1240
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Country | US
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Telephone | 507-929-0733
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED PSYCHOLOGIST
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Name | JIM HORGAN
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Credential | LP
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Telephone | 507-929-0733
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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 | LP3371
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License Number State | MN
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