Provider Demographics
NPI:1871894931
Name:SHEEHAN PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:SHEEHAN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:SHEEHAN BLOCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:651-235-6665
Mailing Address - Street 1:518 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4913
Mailing Address - Country:US
Mailing Address - Phone:651-235-6665
Mailing Address - Fax:651-275-1198
Practice Address - Street 1:6381 OSGOOD AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6118
Practice Address - Country:US
Practice Address - Phone:651-235-6665
Practice Address - Fax:651-275-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1733103TC1900X
MN690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty