Parkside Psychology, Inc.

LBN: Parkside Psychology, Inc.
Parkside Psychology, Inc. is an health care organization with primary practice located at 2124 Dupont Ave S 104, Minneapolis MN 55405-2700. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as the primary health care specialty. Parkside Psychology, Inc. can be contacted via phone (612) 871-4336, or through Moore, Sally Ruth via phone (612) 871-4336.

Contact Information

Primary practice address
2124 Dupont Ave S 104 Minneapolis MN 55405-2700
Phone: (612) 871-4336
Fax: (612) 929-2331
Website:
Map and Directions
Authorized official contact:
Name: Moore, Sally Ruth PSY. D
Phone: (612) 871-4336

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP1891 Minnesota

Profile Details

NPI number 1114175791
LBN Legal business name Parkside Psychology, Inc.
DBA Doing business as
Authorized official Moore, Sally Ruth PSY. D
Entity Organization
Organization subpart 1 No
Enumeration date Sep 8th, 2008
Last updated Sep 8th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114175791 NPPES
Minnesota MEDICAID 621853900
Minnesota Other 67Q05MO

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