Provider Demographics
NPI:1568245454
Name:ESSENTIAL PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:ESSENTIAL PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WIEMERSLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:507-383-2560
Mailing Address - Street 1:216 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2982
Mailing Address - Country:US
Mailing Address - Phone:507-383-2560
Mailing Address - Fax:
Practice Address - Street 1:216 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2982
Practice Address - Country:US
Practice Address - Phone:507-383-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty