Provider Demographics
NPI:1255431243
Name:ANTHONY, JAMES S (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:PHD, LP
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Mailing Address - Street 1:4444 CENTERVILLE ROAD
Mailing Address - Street 2:#235
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3712
Mailing Address - Country:US
Mailing Address - Phone:651-289-3111
Mailing Address - Fax:651-289-3113
Practice Address - Street 1:4444 CENTERVILLE ROAD
Practice Address - Street 2:#235
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55127-3712
Practice Address - Country:US
Practice Address - Phone:651-289-3111
Practice Address - Fax:651-426-6766
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP1905103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103077OtherU CARE
MN202550700Medicaid
MN21390CE-47774ANOtherBC/BS
MN61-13267OtherUBH
MN61-13267OtherUBH