Individual
MARK O JUSTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LP
Contact information
Practice address
11010 PRAIRIE LAKES DR, SUITE 350, EDEN PRAIRIE, MN 55344-3884
(952) 746-2522
(952) 746-0887
Mailing address
1900 SILVER LAKE RD NW, 110, NEW BRIGHTON, MN 55112-1786
(651) 379-1718
(651) 379-1738
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP0329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
818549200
—
MN
Enumeration date
09/16/2006
Last updated
03/12/2014
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