Provider Demographics
NPI:1790842821
Name:NASH, JOHN KIRBY (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KIRBY
Last Name:NASH
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5923
Mailing Address - Country:US
Mailing Address - Phone:952-844-0619
Mailing Address - Fax:952-844-0628
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-844-0619
Practice Address - Fax:952-844-0628
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4K592BEOtherBCBSMN GROUP #
MN4K592NAOtherBCBSMN INDIVIDUAL #
MN074381OtherVALUE OPTIONS #