Organization
PATHWAYS PSYCHOLOGY ON GRAND, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL R LEBLOND PSYD, LP (HIPAA OFFICER)
(651) 287-0931
Entity
Organization
Contact information
Practice address
1053 GRAND AVE, SUITE 116, SAINT PAUL, MN 55105-3022
(651) 287-0931
(651) 287-0967
Mailing address
1053 GRAND AVE, SUITE 116, SAINT PAUL, MN 55105-3022
(651) 287-0931
(651) 287-0967
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
626K2PA
BLUE CROSS BLUE SHIELD ID
MN
05
—
9374051000
—
MN
Enumeration date
08/11/2006
Last updated
11/21/2008
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