MEDICARE: HUMANIST PSYCHOTHERAPY CENTER INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07536HU	OTHER	MN	BLUE CROSS BLUE SHIELD MN

General Provider Information

NPI Number	:	1427242205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMANIST PSYCHOTHERAPY CENTER INC

Provider Business Mailing Address
First Line	:	2245 ST CLAIR AV
Second Line	:
City	:	ST PAUL
State	:	MN
Zip	:	55105-1153
Country	:	US
Telephone Number	:	651-278-4003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 ST CLAIR AV
Second Line	:
City	:	ST PAUL
State	:	MN
Zip	:	55105-1153
Country	:	US
Telephone Number	:	651-278-4003
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER / VICE PRESIDENT
Name	:	JANICE DIETERLEN SEGAL
Credential	:
Telephone Number	:	651-278-4003

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	05/07/2024

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