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General NPI Number Information
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NPI Number | 1750326401
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Entity Type | Individual
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Provider Name | ELIZABETH ANN BUHL PSYD LP
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Gender | Female
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 600 25TH AVE S SUITE 109 ROOSEVELT OFFICE PARK
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City | SAINT CLOUD
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State | MN
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Zip | 56301-4841
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Country | US
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Telephone | 320-255-0343
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Fax | 320-654-0318
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Provider Business Mailing Address
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Address Line | 600 25TH AVE S SUITE 109 ROOSEVELT OFFICE PARK
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City | SAINT CLOUD
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State | MN
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Zip | 56301-4841
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Country | US
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Telephone | 320-255-0343
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Fax | 320-654-0318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4637
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License Number State | MN
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