Provider Demographics
NPI:1851452908
Name:CIRCLE OF CRANES PSYCHOLOGY CENTER,L.L.C.
Entity Type:Organization
Organization Name:CIRCLE OF CRANES PSYCHOLOGY CENTER,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-546-1662
Mailing Address - Street 1:PO BOX 27314
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-0314
Mailing Address - Country:US
Mailing Address - Phone:763-546-1662
Mailing Address - Fax:
Practice Address - Street 1:315 GEORGIA AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4978
Practice Address - Country:US
Practice Address - Phone:763-546-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1876103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty