Individual
DR. PAUL RUSSELL ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD, LP
Contact information
Practice address
4027 COUNTY ROAD 25, ST LOUIS PARK, MN 55416
(612) 925-6033
(612) 925-8496
Mailing address
4240 PARK GLEN RD, ST LOUIS PARK, MN 55416-5427
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6366
MN
Other
Enumeration date
10/28/2009
Last updated
03/18/2019
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