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General NPI Number Information
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NPI Number | 1932502804
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Entity Type | Organization
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Legal Business Name | CARLI BRAUN KODY, PHD, LP, L.L.C.
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 03/06/2022
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Provider Practice Location Address
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Address Line | 700 COMMERCE DR STE 295
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City | WOODBURY
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State | MN
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Zip | 55125-9245
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Country | US
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Telephone | 651-272-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 700 COMMERCE DR STE 295
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City | WOODBURY
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State | MN
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Zip | 55125-9245
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Country | US
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Telephone | 651-272-9777
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | CARLI BRAUN KODY
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Credential | PHD, LP
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Telephone | 651-272-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP 5404
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | LP 5404
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP 5404
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License Number State | MN
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