Provider Demographics
NPI:1881915874
Name:PARACLETE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:PARACLETE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-864-2417
Mailing Address - Street 1:1030 COUNTY ROAD E W
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8152
Mailing Address - Country:US
Mailing Address - Phone:715-864-2417
Mailing Address - Fax:651-528-8705
Practice Address - Street 1:1030 COUNTY ROAD E W
Practice Address - Street 2:SUITE 260
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8152
Practice Address - Country:US
Practice Address - Phone:715-864-2417
Practice Address - Fax:651-528-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5005251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health