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Organization
ASSOCIATED CLINIC OF PSYCHOLOGY INC
Active
Organization
ASSOCIATED CLINIC OF PSYCHOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN E BROSE PHD LP (CEO)
(612) 925-6033
Entity
Organization
Contact information
Practice address
4027 COUNTY ROAD 25, ST LOUIS PARK, MN 55416
(612) 925-6033
(612) 925-8496
Mailing address
4240 PARK GLEN RD, ST LOUIS PARK, MN 55416-4758
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
811029-1-MHC
MN
261QM0850X
Adult Mental Health Clinic/Center
811029-1-MHC
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
811029-1-MHC
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277723100
—
MN
01
—
3920
HEALTHPARTNERS
MN
01
—
475-94AS
BCBS
MN
01
—
CT0661
RAILROAD MEDICARE
MN
Enumeration date
11/01/2006
Last updated
09/06/2018
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