Organization
ACT PSYCHOLOGICAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT DAVID SMALLWOOD PH.D. (CLINICAL LICENSED PSYCHOLOGIST)
(612) 836-3886
Entity
Organization
Contact information
Practice address
4601 EXCELSIOR BLVD STE 507A, SAINT LOUIS PARK, MN 55416-4977
(612) 836-3886
Mailing address
1028 PIKE LAKE DR, NEW BRIGHTON, MN 55112-2427
(612) 836-3886
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP5358
MN
Other
Enumeration date
06/26/2013
Last updated
06/26/2013
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