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Individual

BRIAN EDWARD POWERS II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
4500 PARK GLEN RD, SUITE 155, ST LOUIS PARK, MN 55416-4871
(612) 986-4397
(952) 495-1409
Mailing address
4500 PARK GLEN RD, SUITE 155, ST LOUIS PARK, MN 55416-4871
(612) 986-4397
(952) 495-1409

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2546
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5H617PO
BLUE CROSS ID
MN
01
61-42917
UBH ID
MN
Enumeration date
07/24/2006
Last updated
09/05/2024
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