Organization
THE TERRACE GROUP LTD
Active
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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