Individual
CLINTON VANLITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
500 OSBORNE RD NE STE 255, FRIDLEY, MN 55432-2768
(763) 786-6011
(763) 236-2505
Mailing address
500 OSBORNE RD NE STE 255, FRIDLEY, MN 55432-2768
(763) 786-6011
(763) 236-2505
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
315
ND
103T00000X
Psychologist
Primary
LP3858
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10518
—
ND
01
—
LP3858
MN BOARD OF PSYCHOLOGY STATE LICENSE
MN
Enumeration date
11/21/2006
Last updated
07/21/2022
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