Provider Demographics
NPI:1003576653
Name:CENTER FOR PSYCHOLOGICAL GROWTH AND RESILIENCE
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOLOGICAL GROWTH AND RESILIENCE
Other - Org Name:CPGR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:952-222-8162
Mailing Address - Street 1:4317 UPTON AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1540
Mailing Address - Country:US
Mailing Address - Phone:952-222-8162
Mailing Address - Fax:
Practice Address - Street 1:4317 UPTON AVE S STE A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1540
Practice Address - Country:US
Practice Address - Phone:952-222-8162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty