Organization
GREAT RIVER PSYCHOTHERAPY PLLC
Active
Organization
GREAT RIVER PSYCHOTHERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA PAIGE ROGERS PHD (CO-OWNER)
(651) 503-7391
Entity
Organization
Contact information
Practice address
790 CLEVELAND AVE S STE 201, SAINT PAUL, MN 55116-3845
(651) 503-7391
Mailing address
790 CLEVELAND AVE S STE 201, SAINT PAUL, MN 55116-3845
(651) 503-7391
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
680003000
—
MN
Enumeration date
10/16/2019
Last updated
04/08/2020
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