Organization
SUMUS HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ANTHONY BLACKBURN PHD (CO-OWNER)
(612) 418-9391
Entity
Organization
Contact information
Practice address
6020 302ND ST, STACY, MN 55079-9649
(612) 418-9391
Mailing address
6020 302ND ST, STACY, MN 55079-9649
(612) 418-9391
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134293400
—
MN
Enumeration date
04/10/2021
Last updated
04/10/2021
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