Organization
PHILIP PSYCHOLOGICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PONVELIL PHILIPOSE PHILIP PHD CLINICAL PSYCH (OWNER DIRECTOR)
(507) 345-5049
Entity
Organization
Contact information
Practice address
510 SIBLEY STREET, SUITE 200, MANKATO, MN 56001
(207) 345-5049
(507) 345-5049
Mailing address
510 SIBLEY STREET, SUITE 200, MANKATO, MN 56001
(207) 345-5049
(507) 345-5049
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2258
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41516PH
BCBS
MN
Enumeration date
02/14/2008
Last updated
02/14/2008
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