Provider Demographics
NPI:1417461468
Name:NORTHERN THERAPY AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NORTHERN THERAPY AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOJTECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-568-7622
Mailing Address - Street 1:MOLLY PROFESSIONAL BUILDING PHASE 2
Mailing Address - Street 2:13750 CROSSTOWN DRIVE SUITE L102
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:763-568-7622
Mailing Address - Fax:763-703-5900
Practice Address - Street 1:13750 CROSSTOWN DR NW STE L102
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-5854
Practice Address - Country:US
Practice Address - Phone:763-568-7622
Practice Address - Fax:763-703-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty