Individual
RANDAL RICHARD STAATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2414 PARK AVE, MINNEAPOLIS, MN 55404-3713
(612) 879-5362
Mailing address
2414 PARK AVE, MINNEAPOLIS, MN 55404-3713
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP3816
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215936800
—
MN
Enumeration date
10/13/2006
Last updated
06/30/2010
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