Organization
TELEPSYCHUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAU MACADOR QUEEGLAY LPCC (OWNER)
(612) 462-5121
Entity
Organization
Contact information
Practice address
8518 SOUTH MAPLEBROOK CIRCLE, BROOKLYN PARK, MN 55445
(612) 462-5121
Mailing address
275 4TH ST E STE 807, SAINT PAUL, MN 55101-1687
(612) 462-5121
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417510165
—
MN
Enumeration date
10/28/2020
Last updated
10/23/2024
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