Organization
THE TERRACE GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LELAND KARL MARTIN PHD LP (CLINICAL DIRECTOR)
(952) 595-0562
Entity
Organization
Contact information
Practice address
10580 WAYZATA BLVD, STE 150, MINNETONKA, MN 55305-1657
(952) 595-0562
(952) 595-0564
Mailing address
10580 WAYZATA BLVD, STE 150, MINNETONKA, MN 55305-1657
(952) 595-0562
(952) 595-0564
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3094
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25G82TE
BCBS
MN
01
—
50358
HEALTH PARTNERS
MN
01
—
5H812MA
BCBS
MN
01
—
C04096
MEDICARE
MN
Enumeration date
05/27/2006
Last updated
03/27/2008
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