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NPI Code Detail

MEDICARE: DR. CASEY DANIEL LLOYD PSYD, LP

MEDICARE: DR. CASEY DANIEL LLOYD PSYD, LP
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 Psychologist6217MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16217OTHERMNLICENSED PSYCHOLOGIST NUMBER

General Provider Information

NPI Number : 1679071823
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CASEY DANIEL LLOYD PSYD, LP
Provider Business Mailing Address
First Line : 3620 SNELLING AVE APT 1
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-2785
Country : US
Telephone Number : 763-301-0389
Fax Number :
Provider Business Practice Location Address
First Line : 675 E NICOLLET BLVD STE 250
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6768
Country : US
Telephone Number : 952-977-4046
Fax Number : 952-977-4058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2018
Last Update Date : 01/23/2018

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