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General NPI Number Information
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NPI Number | 1669464905
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Entity Type | Individual
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Provider Name | JOHN MARK PRICHARD PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 1500 MCANDREWS RD W SUITE 209
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 952-808-3166
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Fax | 952-892-1722
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Provider Business Mailing Address
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Address Line | 1500 MCANDREWS RD W SUITE 209
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 952-808-3166
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Fax | 952-892-1722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP0623
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License Number State | MN
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