Provider Demographics
NPI:1427152933
Name:REPP, PATRICK JAMES (MA, LP)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:REPP
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-7058
Mailing Address - Country:US
Mailing Address - Phone:651-486-4828
Mailing Address - Fax:651-482-9119
Practice Address - Street 1:3499 LEXINGTON AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-7058
Practice Address - Country:US
Practice Address - Phone:651-486-4828
Practice Address - Fax:651-482-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2263103TC1900X
MN0265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist