Provider Demographics
NPI:1659301398
Name:COUNSELING PSYCHOLOGISTS OF WOODBURY, P.A.
Entity Type:Organization
Organization Name:COUNSELING PSYCHOLOGISTS OF WOODBURY, P.A.
Other - Org Name:COUNSELING PSYCHOLOGISTS OF ST. PAUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:651-739-7539
Mailing Address - Street 1:7582 CURRELL BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2262
Mailing Address - Country:US
Mailing Address - Phone:651-739-7539
Mailing Address - Fax:651-730-9200
Practice Address - Street 1:7582 CURRELL BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2262
Practice Address - Country:US
Practice Address - Phone:651-739-7539
Practice Address - Fax:651-730-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP3073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN214351800Medicaid
MNC04312Medicare PIN