Provider Demographics
NPI:1316003874
Name:HALPER, DAVID PHILLIP (MA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PHILLIP
Last Name:HALPER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 UPPER 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-3833
Mailing Address - Country:US
Mailing Address - Phone:651-336-6942
Mailing Address - Fax:
Practice Address - Street 1:1310 HIGHWAY 96 E STE 104C
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3618
Practice Address - Country:US
Practice Address - Phone:651-756-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist