NPI Details
PSYCHOLOGICAL&BEHAVIORALCONSULTANTSPA is a psychologist in White Bear Lake, MN. The provider is a psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. PSYCHOLOGICAL&BEHAVIORALCONSULTANTSPA NPI is 1811026123. The provider is registered as an organization entity type and is a single specialty group.
The provider's business location address is:
2186 3RD ST
SUITE 105
WHITE BEAR LAKE, MN
ZIP 55110-263
Phone: (651) 227-8880
Fax: (651) 227-8908
The provider's authorized official is W S Balcerzak .
The authorized official title is Ceo and has the following contact phone number (651) 227-8880.
The enumeration date for this NPI number is 3/4/2007 and was last updated on 2/24/2013.
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 103T00000X | Psychologist | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | C04211 | MEDICARE ID-TYPE UNSPECIFIED | MINNESOTA | |
| 2 | 998518200 | MEDICAID | MINNESOTA | |
