Provider Demographics
NPI:1164532537
Name:HARRINGTON, KEVIN M (PHD LP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:HARRINGTON
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8009 34TH AVE S STE 1490
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1794
Mailing Address - Country:US
Mailing Address - Phone:612-766-9255
Mailing Address - Fax:952-854-5062
Practice Address - Street 1:2720 FAIRVIEW AVE N STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1306
Practice Address - Country:US
Practice Address - Phone:651-241-5290
Practice Address - Fax:651-241-5248
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN396352700Medicaid