Provider Demographics
NPI:1700276011
Name:FRIENDLY PSYCHOLOGICAL PROFESSIONALS
Entity type:Organization
Organization Name:FRIENDLY PSYCHOLOGICAL PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:651-208-1231
Mailing Address - Street 1:301 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GOODHUE
Mailing Address - State:MN
Mailing Address - Zip Code:55027-9026
Mailing Address - Country:US
Mailing Address - Phone:651-208-1231
Mailing Address - Fax:
Practice Address - Street 1:1575 LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5577
Practice Address - Country:US
Practice Address - Phone:651-208-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health