Organization
JAMES AVENUE PSYCHOLOGICAL CONSULTATION, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA MISSY BLAIR PHD (PRESIDENT)
(612) 227-2829
Entity
Organization
Contact information
Practice address
3005 JAMES AVE S, MINNEAPOLIS, MN 55408-2533
(612) 227-2829
(612) 377-7501
Mailing address
3220 HAMPSHIRE AVE N, CRYSTAL, MN 55427-2249
(612) 227-2829
(612) 377-7501
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
LP3550
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117T6NA OR 114T7NA
BLUE CROSS BLUE SHIELD
MN
01
—
141774
UCARE
MN
01
—
20258-11
BHP
MN
01
—
6173818
MEDICA OR UBH
MN
Enumeration date
12/02/2006
Last updated
12/12/2022
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