Provider Demographics
NPI:1134342033
Name:COMINS, JEFFREY RUSSELL (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RUSSELL
Last Name:COMINS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 CURVE CREST BLVD W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5090
Mailing Address - Country:US
Mailing Address - Phone:651-439-2940
Mailing Address - Fax:651-439-2949
Practice Address - Street 1:1825 CURVE CREST BLVD W
Practice Address - Street 2:SUITE 200
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5090
Practice Address - Country:US
Practice Address - Phone:651-439-2940
Practice Address - Fax:651-439-2949
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical