Provider Demographics
NPI:1811328511
Name:CHRISTA SUERKEN, PSY.D., PLC
Entity type:Organization
Organization Name:CHRISTA SUERKEN, PSY.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUERKEN
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:763-843-5548
Mailing Address - Street 1:600 TWELVE OAKS CENTER DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4501
Mailing Address - Country:US
Mailing Address - Phone:763-843-5548
Mailing Address - Fax:
Practice Address - Street 1:600 TWELVE OAKS CENTER DR
Practice Address - Street 2:SUITE 216
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4501
Practice Address - Country:US
Practice Address - Phone:763-843-5548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4709251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health