Doctor Name: | DR. ROBERT GORDON NEAL |
NPI Number: | 1053464859 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | LP4666 |
Business Practice Address: | 3842 Linden Ave White Bear Lake, MN - 551106207 |
Business Phone Number: | 6512357668 |
Business Fax Number: | |
Mailing Address: | 3842 Linden Ave, WHITE BEAR LAKE |
State: | MN |
Postal Code: | 551106207 |
Phone Number: | 6512357668 |
Fax Number: | |
NPI Enumeration Date: | 01/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | LP4666 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |