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General NPI Number Information
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NPI Number | 1740506393
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Entity Type | Organization
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Legal Business Name | PRAIRIE PSYCHOLOGICAL SERVICES PA
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 205 W FLETCHER ST
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City | CROOKSTON
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State | MN
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Zip | 56716-1945
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Country | US
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Telephone | 281-281-2117
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W FLETCHER ST
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City | CROOKSTON
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State | MN
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Zip | 56716-1945
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Country | US
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Telephone | 281-281-2117
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Fax |
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Authorized Official
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Title or Position | OWNER AND DIRECTOR
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Name | DR. DAVID G JANSEN
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Credential | PH.D.
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Telephone | 218-281-2117
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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 |
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License Number State | MN
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