Provider Demographics
NPI:1679071823
Name:LLOYD, CASEY DANIEL (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:DANIEL
Last Name:LLOYD
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 1:3620 SNELLING AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2785
Mailing Address - Country:US
Mailing Address - Phone:763-301-0389
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6768
Practice Address - Country:US
Practice Address - Phone:952-977-4046
Practice Address - Fax:952-977-4058
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6217OtherLICENSED PSYCHOLOGIST NUMBER