MEDICARE: FRIENDLY PSYCHOLOGICAL PROFESSIONALS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700276011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDLY PSYCHOLOGICAL PROFESSIONALS

Provider Business Mailing Address
First Line	:	301 1ST AVE
Second Line	:
City	:	GOODHUE
State	:	MN
Zip	:	55027-9026
Country	:	US
Telephone Number	:	651-208-1231
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 LONG LAKE RD
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-5577
Country	:	US
Telephone Number	:	651-208-1231
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. TIMOTHY L KUSS
Credential	:	M.S.ED
Telephone Number	:	651-208-1231

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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