Organization
PSYCHOLOGICAL CONSULTANTS OF SO MN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL REITMAN PH.D. (OWNER)
(612) 508-9309
Entity
Organization
Contact information
Practice address
4663 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 55110-3300
(612) 508-9309
Mailing address
3230 ORCHARD CT, WHITE BEAR LAKE, MN 55110-5385
(612) 508-9309
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007131
PREFERRED ONE
MN
01
—
41511PS
BLUE CROSS MINNESOTA
MN
05
—
452444600
—
MN
Enumeration date
03/21/2007
Last updated
04/29/2013
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