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General NPI Number Information
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NPI Number | 1790986669
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Entity Type | Organization
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Legal Business Name | DIANNE L. MEIXNER PSYCHOTHERAPY P.A.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 357 KELLOGG BLVD E
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City | SAINT PAUL
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State | MN
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Zip | 55101-1411
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Country | US
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Telephone | 651-287-0846
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Fax |
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Provider Business Mailing Address
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Address Line | 357 KELLOGG BLVD E
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City | SAINT PAUL
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State | MN
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Zip | 55101-1411
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Country | US
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Telephone | 651-287-0846
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST, OWNER
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Name | MS. DIANNE LYNN MEIXNER
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Credential | MA, LICSW, LMFT, ATR
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Telephone | 651-287-0846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 613
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4649
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License Number State | MN
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