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Organization
JAMES AVENUE PSYCHOLOGICAL CONSULTATION, P.A.
Active
Organization
JAMES AVENUE PSYCHOLOGICAL CONSULTATION, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA MISSY BLAIR PHD (PRESIDENT)
(612) 227-2829
Entity
Organization
Contact information
Practice address
3005 JAMES AVE S, MINNEAPOLIS, MN 55408-2533
(612) 227-2829
(612) 377-7501
Mailing address
3220 HAMPSHIRE AVE N, CRYSTAL, MN 55427-2249
(612) 227-2829
(612) 377-7501
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
LP3550
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117T6NA OR 114T7NA
BLUE CROSS BLUE SHIELD
MN
01
—
141774
UCARE
MN
01
—
20258-11
BHP
MN
01
—
6173818
MEDICA OR UBH
MN
Enumeration date
12/02/2006
Last updated
12/12/2022
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