Provider Demographics
NPI:1114974201
Name:THE TERRACE GROUP LTD
Entity Type:Organization
Organization Name:THE TERRACE GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:952-595-0562
Mailing Address - Street 1:10580 WAYZATA BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1657
Mailing Address - Country:US
Mailing Address - Phone:952-595-0562
Mailing Address - Fax:952-595-0564
Practice Address - Street 1:10580 WAYZATA BLVD
Practice Address - Street 2:STE 150
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1657
Practice Address - Country:US
Practice Address - Phone:952-595-0562
Practice Address - Fax:952-595-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5H812MAOtherBCBS
MNC04096OtherMEDICARE
MN50358OtherHEALTH PARTNERS
MN25G82TEOtherBCBS