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General NPI Number Information
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NPI Number | 1952544934
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Entity Type | Organization
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Legal Business Name | GREAT RIVER PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 403 4TH ST NW SUITE 245
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City | BEMIDJI
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State | MN
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Zip | 56601-3142
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Country | US
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Telephone | 218-444-6912
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Fax | 218-444-6937
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Provider Business Mailing Address
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Address Line | 403 4TH ST NW SUITE 245
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City | BEMIDJI
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State | MN
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Zip | 56601-3142
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Country | US
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Telephone | 218-444-6912
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Fax | 218-444-6937
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Authorized Official
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Title or Position | PSYCHOLOGIST, OWNER
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Name | DR. JEAN ANN CHRISTENSEN
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Credential | PSYD,
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Telephone | 218-759-1576
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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 | LP3903
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License Number State | MN
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