Organization
BEHAVIORAL MANAGEMENT PA
Active
Organization
BEHAVIORAL MANAGEMENT PA
Active
Other names
Behavioral Medical Interventions
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RADERSTORF (PRESIDENT)
(952) 927-0184
Entity
Organization
Contact information
Practice address
7211 OHMS LN, EDINA, MN 55439-2148
(952) 927-0184
Mailing address
7211 OHMS LN, EDINA, MN 55439-2148
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16613
HEALTHPARTNERS
MN
Enumeration date
05/22/2007
Last updated
08/22/2020
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