Provider Demographics
NPI:1164610598
Name:GARY P. LIABOE, PHD, LP, LLC
Entity Type:Organization
Organization Name:GARY P. LIABOE, PHD, LP, LLC
Other - Org Name:CORNERSTONE PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LIABOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:651-389-4400
Mailing Address - Street 1:3820 CLEVELAND AVE N
Mailing Address - Street 2:ST 400
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3285
Mailing Address - Country:US
Mailing Address - Phone:651-389-4400
Mailing Address - Fax:651-389-4410
Practice Address - Street 1:3820 CLEVELAND AVE N
Practice Address - Street 2:ST 400
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3285
Practice Address - Country:US
Practice Address - Phone:651-389-4400
Practice Address - Fax:651-389-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0737103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN324L6COOtherBLUECROSS/BLUESHIELD
MN80174310OtherWAUSAU
MN97095547005OtherPREFERRED ONE
MN191366OtherVALUE OPTIONS
MN6142913OtherUNITED BEHARIORAL HEALTH
MN8017430OtherPATIENT CHOICE
MN232253OtherPACIFIC LIFE
MN0005947146OtherAETNA
MN6142913OtherUNITED BEHARIORAL HEALTH
MN232253OtherPACIFIC LIFE
MN191366OtherVALUE OPTIONS
MNC03669Medicare PIN
MN6142913OtherUNITED BEHARIORAL HEALTH