1952505323 NPI number — KERBER PSYCHOLOGICAL SERVICES LLC

Table of content: (NPI 1952505323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952505323 NPI number — KERBER PSYCHOLOGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERBER PSYCHOLOGICAL SERVICES LLC
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:
1952505323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
562 BAVARIA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHASKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-457-0572
Provider Business Mailing Address Fax Number:
714-274-7197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
562 BAVARIA LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHASKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-457-0572
Provider Business Practice Location Address Fax Number:
714-274-7197
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERBER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
BERNARD
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
952-457-0572

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LP4084 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 034N2KE . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6173120 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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