Provider Demographics
NPI:1780789883
Name:SKOVHOLT, THOMAS M (PHD,LP)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:SKOVHOLT
Suffix:
Gender:M
Credentials:PHD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6860 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1411
Mailing Address - Country:US
Mailing Address - Phone:763-560-4860
Mailing Address - Fax:763-503-1430
Practice Address - Street 1:6860 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1411
Practice Address - Country:US
Practice Address - Phone:763-560-4860
Practice Address - Fax:763-503-1430
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP0316103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680000321Medicare ID - Type Unspecified