Organization
CHILD PSYCHOLOGY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA SULLIVAN EHLERT PSY.D. (PSYCHOLOGIST)
(612) 284-1557
Entity
Organization
Contact information
Practice address
12940 HARRIET AVE S, SUITE 250, BURNSVILLE, MN 55337-2680
(612) 284-1557
(952) 432-3826
Mailing address
12940 HARRIET AVE S, SUITE 250, BURNSVILLE, MN 55337-2680
(612) 284-1557
(952) 432-3826
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP5415
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218191033686
PREFERRED ONE
MN
01
—
66G85CH
BLUE CROSS BUSINESS
MN
Enumeration date
04/25/2007
Last updated
06/19/2013
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