Provider Demographics
NPI:1033357355
Name:NORTHSTAR PSYCHOLOGICAL, PLLC
Entity Type:Organization
Organization Name:NORTHSTAR PSYCHOLOGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GELMER
Authorized Official - Last Name:VAN NOORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:612-275-7564
Mailing Address - Street 1:20669 FENSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9810
Mailing Address - Country:US
Mailing Address - Phone:612-275-7564
Mailing Address - Fax:651-982-0910
Practice Address - Street 1:8009 34TH AVE S
Practice Address - Street 2:RIVERVIEW OFFICE TOWER, SUITE 1490
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1608
Practice Address - Country:US
Practice Address - Phone:612-275-7564
Practice Address - Fax:952-854-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4888251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health