Provider Demographics
NPI:1285665877
Name:ASSOCIATED PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:ASSOCIATED PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:507-388-8114
Mailing Address - Street 1:113 E HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3630
Mailing Address - Country:US
Mailing Address - Phone:507-388-8114
Mailing Address - Fax:507-388-8068
Practice Address - Street 1:113 E HICKORY ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3630
Practice Address - Country:US
Practice Address - Phone:507-388-8114
Practice Address - Fax:507-388-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3219103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121989OtherUCARE PROV ID
MN136497OtherUCARE GR#
MN755295500Medicaid
MN060H0ASOtherBCBS GROUP #
MN6128537OtherMEDICA-UBH PROV ID
MN84732OtherHEALTH PARTNERS GR#
MNC05525OtherMEDICARE PTAN