Organization
PROFESSIONAL PSYCHOLOGICAL SERVICES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN MARGARET BORER RN., LICSW (CEO/PRESIDENT)
(651) 353-0133
Entity
Organization
Contact information
Practice address
3352 SHERMAN CT, SUITE 104, EAGAN, MN 55121-5003
(651) 353-0133
(651) 905-0464
Mailing address
608 HAMPSHIRE DR, MENDOTA HEIGHTS, MN 55120-1932
(651) 353-0133
(651) 905-0464
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
16437
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
877621100
—
MN
Enumeration date
01/08/2009
Last updated
01/08/2009
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