| Organization Name: | PARK PSYCHOTHERAPY & CONSULTING INC |
| NPI Number: | 1023153491 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURA J TRIPET DODGE (CEO) |
| Mailing Address: | 4601 Excelsior Blvd Suite 501 St Louis Park |
| State: | MN US |
| Postal Code: | 55416 |
| Phone Number: | 9529270170 |
| Fax Number: | 9529277027 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TP2701X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Group Psychotherapy |
| Taxonomy Definition: | |