Brian J Gatheridge
Psychologist Clinical Child & Adolescent Psychologist
1245 Washington Ave
Detroit Lakes
, Minnesota 56501-3905
Brian J Gatheridge
Psychologist Clinical Child & Adolescent Psychologist
1245 Washington Ave
Detroit Lakes
, Minnesota 56501-3905
(218) 846-2000
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About
Features
Specialties
- Psychologist
- Clinical Child & Adolescent Psychologist
Languages spoken
- English
Location
First Address
- Brian J Gatheridge
- 1219 S. Washington Ave
- Detroit Lakes, MN
- Zip : 56501-3905
- Phone : (218) 846-2000
Second Address
- Brian J Gatheridge
- 1245 Washington Ave
- Detroit Lakes, MN
- Zip : 56501-3905
- Phone : (218) 846-2000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 102L00000X | Psychologist | LP4970 | MN |
| Y | 103T00000X | Psychologist | LP4970 | MN |
| N | 103TC2200X | Clinical Child & Adolescent Psychologist |
National Provider Identifier
| NPI | 1043465644 |
|---|---|
| Provider Name | Brian J Gatheridge |
| First Address | Detroit Lakes, MN 56501-3905 |
| Second Address | Detroit Lakes, MN 56501-3905 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/11/2008 |
| Last Update Date | 28/05/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.