Provider Demographics
NPI:1457680266
Name:GEMMELL, VAN MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:MARK
Last Name:GEMMELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:563 BIELENBERG DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4425
Mailing Address - Country:US
Mailing Address - Phone:651-829-6610
Mailing Address - Fax:651-739-1998
Practice Address - Street 1:563 BIELENBERG DR
Practice Address - Street 2:SUITE 125
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4425
Practice Address - Country:US
Practice Address - Phone:651-829-6610
Practice Address - Fax:651-739-1998
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP5177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical