Organization
SPEARE PSYCHOLOGICAL SERVICES PA
Active
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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