Provider Demographics
NPI:1528343738
Name:DEAN, NATHAN RYAN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RYAN
Last Name:DEAN
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:LYN
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:1041 GRAND AVE # 325
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3002
Mailing Address - Country:US
Mailing Address - Phone:651-231-9936
Mailing Address - Fax:651-647-5723
Practice Address - Street 1:1041 GRAND AVE # 325
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3002
Practice Address - Country:US
Practice Address - Phone:651-231-9936
Practice Address - Fax:651-647-5723
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5397103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1528343738Medicaid
MN680003248OtherMEDICARE PTAN