Organization
THE INSTITUTE FOR PSYCHOLOGICAL & SEXUAL HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOS PETSOULIS M.A., L.P. (DIRECTOR)
(218) 727-7353
Entity
Organization
Contact information
Practice address
314 W SUPERIOR ST, SUITE 600, DULUTH, MN 55802-1805
(218) 727-7353
(218) 727-2646
Mailing address
314 W SUPERIOR ST, SUITE 600, DULUTH, MN 55802-1805
(218) 727-7353
(218) 727-2646
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
LP4322
MN
103T00000X
Psychologist
Primary
LP3014
MN
103T00000X
Psychologist
LP3664
MN
1041C0700X
Clinical Social Worker
15629
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29A16IN
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/07/2007
Last updated
12/18/2008
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