Individual
MR. THOMAS WRIGHT BURSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.L.P.
Contact information
Practice address
7515 WAYZATA BLVD, SUITE 210, ST LOUIS PARK, MN 55426-1604
(763) 568-1773
Mailing address
7515 WAYZATA BLVD, SUITE 210, ST. LOUIS PARK, MN 55426
(763) 568-1773
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3770
MN
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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