Provider Demographics
NPI:1457799314
Name:PSYCHOLOGICAL ASSESSMENT SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRESSA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:REISETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-597-2737
Mailing Address - Street 1:621 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-9585
Mailing Address - Country:US
Mailing Address - Phone:612-597-2737
Mailing Address - Fax:763-566-2944
Practice Address - Street 1:621 RED OAK DR
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9585
Practice Address - Country:US
Practice Address - Phone:612-597-2737
Practice Address - Fax:763-566-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4752103TC2200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty