Provider Demographics
NPI:1831445337
Name:POINTER, TODD A (MA, LP)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:POINTER
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12837 MURIEL RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2745
Mailing Address - Country:US
Mailing Address - Phone:612-886-5070
Mailing Address - Fax:
Practice Address - Street 1:1601 SOUTHCROSS DR W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7013
Practice Address - Country:US
Practice Address - Phone:952-224-8990
Practice Address - Fax:952-224-8991
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist