Provider Demographics
NPI:1265610851
Name:AVDEYEVA, TATYANA V (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:V
Last Name:AVDEYEVA
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 STEWART AVE APT 2404
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3173
Mailing Address - Country:US
Mailing Address - Phone:651-699-4190
Mailing Address - Fax:
Practice Address - Street 1:7372 KIRKWOOD CT N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5202
Practice Address - Country:US
Practice Address - Phone:763-416-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4809103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist