Provider Demographics
NPI:1699906412
Name:TENNAPEL, SCOTT A (PHD, LP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:TENNAPEL
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 BROADWAY AVE N
Mailing Address - Street 2:
Mailing Address - City:BRAHAM
Mailing Address - State:MN
Mailing Address - Zip Code:55006-4711
Mailing Address - Country:US
Mailing Address - Phone:320-396-3333
Mailing Address - Fax:320-396-3363
Practice Address - Street 1:521 BROADWAY AVE N
Practice Address - Street 2:
Practice Address - City:BRAHAM
Practice Address - State:MN
Practice Address - Zip Code:55006-4711
Practice Address - Country:US
Practice Address - Phone:320-396-3333
Practice Address - Fax:320-396-3363
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0859103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist