Provider Demographics
NPI:1013352756
Name:LKH PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:LKH PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:612-345-4754
Mailing Address - Street 1:1409 WILLOW ST STE 610
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3283
Mailing Address - Country:US
Mailing Address - Phone:612-345-4754
Mailing Address - Fax:612-345-4757
Practice Address - Street 1:1409 WILLOW ST STE 610
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3283
Practice Address - Country:US
Practice Address - Phone:612-345-4754
Practice Address - Fax:612-345-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty