Organization
FARIBAULT PSYCHOLOGICAL SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN HOLMAN PH.D. LP (PRESIDENT)
(507) 334-6518
Entity
Organization
Contact information
Practice address
329 FARIBAULT RD, FARIBAULT, MN 55021-5780
(507) 334-6518
(507) 333-2307
Mailing address
PO BOX 901, FARIBAULT, MN 55021-0901
(507) 334-6518
(507) 333-2307
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15534
HEALTH PARTNERS
—
01
—
34146HO
BLUE CROSS BLUE SHIELD
MN
01
—
97491
PREFERRED ONE
—
01
—
D179
SOUTH COUNTRY HEALTH CARE
—
Enumeration date
08/23/2005
Last updated
08/22/2020
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