Organization
PROOF ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MOLLIE O'BRIEN (EXECUTIVE DIRECTOR)
(651) 917-2370
Entity
Organization
Contact information
Practice address
1876 MINNEHAHA AVE W, SAINT PAUL, MN 55104-1029
(651) 917-2370
(651) 313-7888
Mailing address
1876 MINNEHAHA AVE W, SAINT PAUL, MN 55104-1029
(651) 917-2370
(651) 313-7888
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5419
MN
Other
Enumeration date
06/19/2012
Last updated
10/07/2024
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