Provider Demographics
NPI:1336214899
Name:LAURA WHITNEY PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LAURA WHITNEY PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:218-263-6600
Mailing Address - Street 1:11206 LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-4423
Mailing Address - Country:US
Mailing Address - Phone:218-263-6600
Mailing Address - Fax:218-263-6600
Practice Address - Street 1:11206 LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-4423
Practice Address - Country:US
Practice Address - Phone:218-263-6600
Practice Address - Fax:218-263-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty