Tatyana V. Avdeyeva, PH.D., L.P.
Individual provider Active NPI Psychologist · Maple Grove, MN
NPI 1265610851 · NPPES record last updated Feb 5, 2008
Key facts
- NPI
- 1265610851
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- LP4809 (MN)
- Practice address
- 7372 Kirkwood CT N
Maple Grove, MN 55369-5202 - Phone
- (763) 416-4167
- NPI assigned
- Feb 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4809 | MN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovative Psychological Consultants, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP4809 | MN | Yes |
Addresses
Primary practice location
7372 Kirkwood CT N
Maple Grove, MN 55369-5202
Mailing address
2285 Stewart Ave Apt 2404
Saint Paul, MN 55116-3173
Phone (651) 699-4190
Other providers in Maple Grove, MN
- Danielle Charlene Athmann
- Atkinson Conseling Services
- Lea Atkinson
- Kimberly Janice Ault
- Alexandra Jean Aune
- Kamil Awnur
- Grace Awoleye
- Katherine Lynn Awoyinka
- William Babb
- Howard L. Bach
All providers in Maple Grove, MN · Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.