Provider Demographics
NPI:1467837922
Name:ANNA TIERNEY PH.D. L.P. LLC
Entity Type:Organization
Organization Name:ANNA TIERNEY PH.D. L.P. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD L P
Authorized Official - Phone:612-237-8979
Mailing Address - Street 1:5101 OLSON MEMORIAL HWY
Mailing Address - Street 2:#400
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5149
Mailing Address - Country:US
Mailing Address - Phone:612-237-8979
Mailing Address - Fax:
Practice Address - Street 1:5101 OLSON MEMORIAL HIGHWAY
Practice Address - Street 2:#400
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:612-237-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherEIN