Individual
JOEL T.G. KIRCHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
705 PLEASANT AVE S, PARK RAPIDS, MN 56470-1440
(218) 732-2800
(218) 732-2874
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(218) 732-2800
(218) 732-2874
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 3232
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346281987
—
MN
01
—
13899
NDBS #
MN
05
—
18686
—
MN
01
—
30T00KI
MNBS #
MN
01
—
30T99KI
MNBS #
MN
05
—
860819900
—
MN
Enumeration date
06/08/2006
Last updated
05/16/2012
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