Organization
SPEARE PSYCHOLOGICAL SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SPEARE PHD LICENSED PSYCHOL (CEO OWNER)
(218) 741-3740
Entity
Organization
Contact information
Practice address
225 1ST ST N, SUITE 3100, VIRGINIA, MN 55723
(218) 741-3740
(218) 741-9492
Mailing address
225 1ST ST N, SUITE 3100, VIRGINIA, MN 55723
(218) 741-3740
(218) 741-9492
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP0655
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000512001
MAGELLAN
MN
01
—
074048
VALUE OPTIONS
MN
01
—
100318
PREFERREDONE
MN
01
—
110500
UCARE
MN
01
—
6101470
UNITED BEHAVIORAL HEALTH
MN
05
—
850347800
—
MN
01
—
8L596SP
BCBS
MN
Enumeration date
04/30/2007
Last updated
08/10/2010
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