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NPI Code Detail

MEDICARE: JOHN HENRY PRIBYL PHD LP LMFT

MEDICARE: JOHN HENRY PRIBYL PHD LP LMFT
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
1103TC0700XClinical Psychologist0374MN
2106H00000XMarriage & Family Therapist0364MN

General Provider Information

NPI Number : 1275505760
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN HENRY PRIBYL PHD LP LMFT
Provider Business Mailing Address
First Line : 8100 34TH AVE S
Second Line : MAIL STOP 33100A
City : BLOOMINGTON
State : MN
Zip : 55425-1672
Country : US
Telephone Number : 952-883-5463
Fax Number : 952-883-5395
Provider Business Practice Location Address
First Line : 5625 CENEX DR
Second Line : MAIL STOP 33100A
City : INVER GROVE HEIGHTS
State : MN
Zip : 55077-1735
Country : US
Telephone Number : 651-552-2600
Fax Number : 651-552-2674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 09/11/2025

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