Provider Demographics
NPI:1134534076
Name:STENLUND PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:STENLUND PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:STENLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MS/LP
Authorized Official - Phone:218-327-8937
Mailing Address - Street 1:516 S POKEGAMA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3800
Mailing Address - Country:US
Mailing Address - Phone:218-327-8937
Mailing Address - Fax:218-327-0348
Practice Address - Street 1:516 S POKEGAMA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3800
Practice Address - Country:US
Practice Address - Phone:218-327-8937
Practice Address - Fax:218-327-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2760251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health