Individual
JAY THOMAS GOURLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2221 FORD PKWY, SAINT PAUL, MN 55116-1800
(651) 645-2227
Mailing address
PO BOX 1239, BRAINERD, MN 56401-9600
(651) 645-2227
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6107401
UBH MEDICA
MN
01
—
69260GO
BCBS
MN
Enumeration date
07/21/2006
Last updated
01/08/2008
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