Individual
DR. ROY JOHN SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, ABPP,LADC,MHA
Contact information
Practice address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
Mailing address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP5295
MN
103TC1900X
Counseling Psychologist
LP5295
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073820379
—
MN
Enumeration date
09/08/2010
Last updated
05/06/2022
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