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General NPI Number Information
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NPI Number | 1700246816
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Entity Type | Organization
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Legal Business Name | MORNINGSTAR PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 2098 THERESA ST
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1306
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Country | US
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Telephone | 651-746-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 3432 DENMARK AVE # 244
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City | EAGAN
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State | MN
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Zip | 55123-1088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ANDREA LYNN LOVETT
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Credential | PH.D.
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Telephone | 651-746-9108
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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 | LP4523
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License Number State | MN
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