Provider Demographics
NPI:1750326401
Name:BUHL, ELIZABETH ANN (PSYD LP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:BUHL
Suffix:
Gender:F
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 1:600 25TH AVE S
Mailing Address - Street 2:SUITE 109 ROOSEVELT OFFICE PARK
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4841
Mailing Address - Country:US
Mailing Address - Phone:320-255-0343
Mailing Address - Fax:320-654-0318
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:SUITE 109 ROOSEVELT OFFICE PARK
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-255-0343
Practice Address - Fax:320-654-0318
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
097H4BUOtherBCBS
HP59542OtherHEALTH PARTNERS
138102OtherUCARE
MN567607000Medicaid
1046154OtherPREFERRED ONE
HP59542OtherHEALTH PARTNERS