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General NPI Number Information
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NPI Number | 1669614483
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Entity Type | Organization
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Legal Business Name | CLINICAL AND FORENSIC PSYCHOLOGY LTD
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 2677 INNSBRUCK DR SUITE D
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City | SAINT PAUL
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State | MN
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Zip | 55112-6395
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Country | US
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Telephone | 612-581-6655
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Fax | 651-633-9485
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 67
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City | BARNUM
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State | MN
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Zip | 55707
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Country | US
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Telephone | 612-581-6655
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Fax | 651-633-9485
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES HARLAN GILBERTSON
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Credential | PHD
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Telephone | 612-581-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LP1768
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License Number State | MN
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