1326242702 NPI number — CENTER FOR PSYCHOLOGICAL AND EDUCATIONAL ASSESSMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326242702 NPI number — CENTER FOR PSYCHOLOGICAL AND EDUCATIONAL ASSESSMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PSYCHOLOGICAL AND EDUCATIONAL ASSESSMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326242702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 CENTENNIAL DR STOP 7108
Provider Second Line Business Mailing Address:
210 MONTGOMERY HALL
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58202-6063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-777-3260
Provider Business Mailing Address Fax Number:
701-777-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 CENTENNIAL DR STOP 7108
Provider Second Line Business Practice Location Address:
210 MONTGOMERY HALL
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58202-6063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-777-3260
Provider Business Practice Location Address Fax Number:
701-777-3454
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETROS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
PROFESSOR OF PSYCHOLOGY
Authorized Official Telephone Number:
701-777-3260

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  231 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14870 . This is a "BC BS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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