Provider Demographics
NPI:1407907397
Name:SIMONSON PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SIMONSON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LP
Authorized Official - Phone:763-639-7462
Mailing Address - Street 1:10267 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434
Mailing Address - Country:US
Mailing Address - Phone:763-639-7462
Mailing Address - Fax:763-786-5462
Practice Address - Street 1:10267 UNIVERSITY AVE
Practice Address - Street 2:#203
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434
Practice Address - Country:US
Practice Address - Phone:763-639-7462
Practice Address - Fax:763-786-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN53M835IOtherBCBS BLUE CROSS BLUE SHIE