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General NPI Number Information
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NPI Number | 1821241340
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL HEALTHCARE OF MINNESOTA PA
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 15798 VENTURE LN
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5729
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Country | US
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Telephone | 952-920-2789
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Fax | 952-746-3890
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Provider Business Mailing Address
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Address Line | 15798 VENTURE LN
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5729
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Country | US
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Telephone | 952-920-2789
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Fax | 952-746-3890
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS GUTHRIE FREY
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Credential | PH.D.
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Telephone | 952-920-2789
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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 | LP 2224
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License Number State | MN
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