Provider Demographics
NPI:1942687397
Name:HOPE PSYCHOLOGY PRACTICE, LLC
Entity Type:Organization
Organization Name:HOPE PSYCHOLOGY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:BENDEV
Authorized Official - Last Name:RAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:612-767-9860
Mailing Address - Street 1:2720 W. 43RD ST.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410
Mailing Address - Country:US
Mailing Address - Phone:612-767-9860
Mailing Address - Fax:612-767-9861
Practice Address - Street 1:2720 W. 43RD ST.
Practice Address - Street 2:SUITE 205
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410
Practice Address - Country:US
Practice Address - Phone:612-767-9860
Practice Address - Fax:612-767-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5587103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty