Provider Demographics
NPI:1467874495
Name:PATEL, ANESH (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ANESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2134
Mailing Address - Country:US
Mailing Address - Phone:612-356-1566
Mailing Address - Fax:612-446-5793
Practice Address - Street 1:1123 GRAND AVE APT 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2744
Practice Address - Country:US
Practice Address - Phone:612-356-1566
Practice Address - Fax:612-446-5793
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5711103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling