Provider Demographics
NPI:1225233406
Name:OLGA GRUN,PHD,PSYD, LLC
Entity Type:Organization
Organization Name:OLGA GRUN,PHD,PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PSYD
Authorized Official - Phone:651-523-8808
Mailing Address - Street 1:1619 DAYTON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6206
Mailing Address - Country:US
Mailing Address - Phone:651-523-8808
Mailing Address - Fax:651-523-8811
Practice Address - Street 1:1619 DAYTON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6206
Practice Address - Country:US
Practice Address - Phone:651-523-8808
Practice Address - Fax:651-523-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty