Provider Demographics
NPI:1295250215
Name:PSYCHOLOGY OF HEALTH
Entity type:Organization
Organization Name:PSYCHOLOGY OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEXAU
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:612-385-8321
Mailing Address - Street 1:1619 DAYTON AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6206
Mailing Address - Country:US
Mailing Address - Phone:612-385-8321
Mailing Address - Fax:
Practice Address - Street 1:1619 DAYTON AVE STE 325
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6206
Practice Address - Country:US
Practice Address - Phone:612-385-8321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4406261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health