MEDICARE: DR. RAYE MCPHILLIPS EYRICH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP0348	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215938659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYE MCPHILLIPS EYRICH PH.D.

Provider Business Mailing Address
First Line	:	4721 HARRIET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-5433
Country	:	US
Telephone Number	:	612-822-1932
Fax Number	:	612-659-1906

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 612
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-203-8660
Fax Number	:	612-659-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/27/2008

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