Provider Demographics
NPI:1740559699
Name:CONSULTING PSYCHOLOGISTS ASSOCIATES
Entity Type:Organization
Organization Name:CONSULTING PSYCHOLOGISTS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:THORDAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-225-0854
Mailing Address - Street 1:2870 HIGHVIEW TER
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1110
Mailing Address - Country:US
Mailing Address - Phone:651-225-0854
Mailing Address - Fax:
Practice Address - Street 1:501 DALE ST N
Practice Address - Street 2:213
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1914
Practice Address - Country:US
Practice Address - Phone:651-225-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1135103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty