Individual
BRIAN J GATHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2000
Mailing address
1219 S. WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4970
MN
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Enumeration date
11/24/2008
Last updated
04/04/2022
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