Provider Demographics
NPI:1932856408
Name:CENTERING YOUR LIFE PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:CENTERING YOUR LIFE PSYCHOLOGY PLLC
Other - Org Name:CENTERING YOUR LIFE PSYCHOLOGY PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KODET
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:612-520-1244
Mailing Address - Street 1:1850 W WAYZATA BLVD # 220
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-4413
Mailing Address - Country:US
Mailing Address - Phone:612-520-1244
Mailing Address - Fax:612-887-9079
Practice Address - Street 1:1850 W WAYZATA BLVD # 220
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-4413
Practice Address - Country:US
Practice Address - Phone:612-520-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750838181Other1750838181