Provider Demographics
NPI:1427242205
Name:HUMANIST PSYCHOTHERAPY CENTER INC
Entity type:Organization
Organization Name:HUMANIST PSYCHOTHERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER / VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:DIETERLEN
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-278-4003
Mailing Address - Street 1:2245 ST CLAIR AV
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1153
Mailing Address - Country:US
Mailing Address - Phone:651-278-4003
Mailing Address - Fax:
Practice Address - Street 1:2245 ST CLAIR AV
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1153
Practice Address - Country:US
Practice Address - Phone:651-278-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07536HUOtherBLUE CROSS BLUE SHIELD MN