Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 5427 | MN |
Y | 103G00000X | Clinical Psychologist | 5427 | MN |
Y | 103TC0700X | Clinical Psychologist | 5427 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 5427 | MN |
NPI | 1073880027 |
---|---|
Provider Name | Dr. Matthew Gene James |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 17/03/2018 |