Provider Demographics
NPI:1043388002
Name:GILBERTSON, HARLAN JAMES (LP)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:JAMES
Last Name:GILBERTSON
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 UNION ST S
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1818
Mailing Address - Country:US
Mailing Address - Phone:320-679-8161
Mailing Address - Fax:320-679-5258
Practice Address - Street 1:630 UNION ST S
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1818
Practice Address - Country:US
Practice Address - Phone:320-679-8161
Practice Address - Fax:320-679-5258
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN LP2591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical