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General NPI Number Information
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NPI Number | 1861051351
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Entity Type | Organization
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Legal Business Name | SOMERS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 16 N SHORE DR
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City | WINNEBAGO
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State | MN
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Zip | 56098-3345
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Country | US
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Telephone | 612-396-1699
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Fax | 507-893-3031
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Provider Business Mailing Address
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Address Line | 16 N SHORE DR
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City | WINNEBAGO
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State | MN
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Zip | 56098-3345
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Country | US
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Telephone | 612-396-1699
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Fax | 507-893-3031
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Authorized Official
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Title or Position | CEO
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Name | PETER SOMERS
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Credential | PH.D.
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Telephone | 612-396-1699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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