Provider Demographics
NPI:1952505323
Name:KERBER PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:KERBER PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KERBER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:952-457-0572
Mailing Address - Street 1:562 BAVARIA LANE
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55386
Mailing Address - Country:US
Mailing Address - Phone:952-457-0572
Mailing Address - Fax:714-274-7197
Practice Address - Street 1:562 BAVARIA LANE
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55386
Practice Address - Country:US
Practice Address - Phone:952-457-0572
Practice Address - Fax:714-274-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4084251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN034N2KEOtherBLUE CROSS
MN6173120OtherUNITED BEHAVIORAL HEALTH
MN6173120OtherUNITED BEHAVIORAL HEALTH