Provider Demographics
NPI:1356902167
Name:NORTHSTAR PSYCHOLOGICAL SERVICES, PLC
Entity type:Organization
Organization Name:NORTHSTAR PSYCHOLOGICAL SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:515-225-6653
Mailing Address - Street 1:4401 WESTOWN PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6721
Mailing Address - Country:US
Mailing Address - Phone:515-225-6653
Mailing Address - Fax:
Practice Address - Street 1:4401 WESTOWN PKWY STE 109
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6721
Practice Address - Country:US
Practice Address - Phone:515-225-6653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-23
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty