Provider Demographics
NPI:1275505760
Name:PRIBYL, JOHN HENRY (PHD LP LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:PRIBYL
Suffix:
Gender:M
Credentials:PHD LP LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 33100A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:5625 CENEX DR
Practice Address - Street 2:MAIL STOP 33100A
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1735
Practice Address - Country:US
Practice Address - Phone:651-552-2600
Practice Address - Fax:651-552-2674
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0374103TC0700X
MN0364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R54527Medicare UPIN