Organization
CENTER FOR PSYCHOLOGICAL CONSULTATION, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES EDWARD BOSCARDIN PH.D. (PRESIDENT)
(612) 719-0856
Entity
Organization
Contact information
Practice address
8085 WAYZATA BLVD, SUITE 100B, GOLDEN VALLEY, MN 55426-1453
(612) 719-0856
(651) 484-8551
Mailing address
1092 LAWNVIEW AVE, SHOREVIEW, MN 55126-8408
(612) 719-0856
(651) 484-8551
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP0709
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710552500
—
MI
Enumeration date
11/18/2011
Last updated
11/18/2011
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