Provider Demographics
NPI:1730243809
Name:DULUTH PSYCHOLOGICAL CLINIC INC
Entity type:Organization
Organization Name:DULUTH PSYCHOLOGICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST LP1240
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:218-722-2005
Mailing Address - Street 1:205 W 2ND ST
Mailing Address - Street 2:SUITE 437 DULUTH PSYCHOLOGICAL CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-722-2005
Mailing Address - Fax:218-727-3000
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:SUITE 437 DULUTH PSYCHOLOGICAL CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-722-2005
Practice Address - Fax:218-727-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty