Provider Demographics
NPI:1649564766
Name:FREY-HAWKINS PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:FREY-HAWKINS PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:SEEDS OF CHANGE PSYCHOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:FREY-HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:507-934-2232
Mailing Address - Street 1:1304 MARSHALL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4500
Mailing Address - Country:US
Mailing Address - Phone:507-934-2232
Mailing Address - Fax:507-934-2096
Practice Address - Street 1:1304 MARSHALL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-4500
Practice Address - Country:US
Practice Address - Phone:507-934-2232
Practice Address - Fax:507-934-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0414251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1093860587Medicaid
MN620000270Medicare PIN