Organization
CORE PROFESSIONAL SERVICES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA WEBER (OFFICE MANAGER)
(218) 839-4785
Entity
Organization
Contact information
Practice address
617 OAK ST, BRAINERD, MN 56401-3610
(218) 829-7140
Mailing address
617 OAK ST, BRAINERD, MN 56401-3610
(218) 829-7140
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
MN
103TC0700X
Clinical Psychologist
0103
MN
103TC0700X
Clinical Psychologist
1517
MN
103TC0700X
Clinical Psychologist
1885
MN
103TC0700X
Clinical Psychologist
2585
MN
103TC0700X
Clinical Psychologist
4630
MN
103TC0700X
Clinical Psychologist
4659
MN
1041C0700X
Clinical Social Worker
00131
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028078000
—
MN
01
—
62G67CO
BCBS
MN
01
—
62G69CO
BCBS
MN
01
—
62G71CO
BCBS
MN
Enumeration date
09/28/2006
Last updated
03/31/2014
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