=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679071823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY DANIEL LLOYD PSYD, LP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2018
-----------------------------------------------------
Last Update Date | 01/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 E NICOLLET BLVD STE 250
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-6768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-977-4046
-----------------------------------------------------
Fax | 952-977-4058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3620 SNELLING AVE APT 1
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55406-2785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-301-0389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6217
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------