Provider Demographics
NPI:1154582138
Name:THOMAS PAUL CARRILLO PH.D.,L.P.P.A.
Entity type:Organization
Organization Name:THOMAS PAUL CARRILLO PH.D.,L.P.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-288-5000
Mailing Address - Street 1:400 S 4TH ST
Mailing Address - Street 2:854
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1411
Mailing Address - Country:US
Mailing Address - Phone:612-288-5000
Mailing Address - Fax:612-288-5002
Practice Address - Street 1:400 S 4TH ST
Practice Address - Street 2:854
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1411
Practice Address - Country:US
Practice Address - Phone:612-288-5000
Practice Address - Fax:612-288-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0339103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty