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General NPI Number Information
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NPI Number | 1902306038
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Entity Type | Organization
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Legal Business Name | KSA PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 5603 CHICAGO AVE.
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City | MINNEAPOLIS
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State | MN
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Zip | 55417
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Country | US
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Telephone | 612-298-9587
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 BROMPTON PLACE
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55118
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Country | US
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Telephone | 612-998-9587
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/MANAGER
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Name | ANGELA SCOTT
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Credential | LP
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Telephone | 612-298-9587
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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 | LP4679
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4436
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4687
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License Number State | MN
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