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General NPI Number Information
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NPI Number | 1740417757
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGY & REHABILITATION SERVICES, LTD
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 1535 LAUREL AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-6739
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Country | US
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Telephone | 651-645-0645
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Fax | 651-645-0630
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Provider Business Mailing Address
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Address Line | 1535 LAUREL AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-6739
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Country | US
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Telephone | 651-645-0645
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Fax | 651-645-0630
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Authorized Official
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Title or Position | CEO/LICENSED PSYCHOLOGIST
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Name | MR. NATHANIEL STEWART JR.
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Credential | M.A.,L.P., Q.R.C,CRC
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Telephone | 651-645-0645
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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 | LP2279
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License Number State | MN
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