Provider Demographics
NPI:1831851054
Name:EDINA PSYCHOLOGY, S.C.
Entity type:Organization
Organization Name:EDINA PSYCHOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:952-300-3388
Mailing Address - Street 1:5604 BEARD AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2340
Mailing Address - Country:US
Mailing Address - Phone:952-994-8462
Mailing Address - Fax:
Practice Address - Street 1:3300 EDINBOROUGH WAY STE 203
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5958
Practice Address - Country:US
Practice Address - Phone:239-300-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty