Provider Demographics
NPI:1992305973
Name:TELEPSYCHUS
Entity type:Organization
Organization Name:TELEPSYCHUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAU
Authorized Official - Middle Name:MACADOR
Authorized Official - Last Name:QUEEGLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-462-5121
Mailing Address - Street 1:275 4TH ST E STE 807
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1687
Mailing Address - Country:US
Mailing Address - Phone:612-462-5121
Mailing Address - Fax:
Practice Address - Street 1:8518 SOUTH MAPLEBROOK CIRCLE
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445
Practice Address - Country:US
Practice Address - Phone:612-462-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1417510165Medicaid