| The Terrace Group Ltd | |
|
10580 Wayzata Blvd Ste 150 Minnetonka MN 55305-1657 | |
| (952) 595-0562 | |
| (952) 595-0564 |
| Full Name | The Terrace Group Ltd |
|---|---|
| Speciality | Psychologist |
| Location | 10580 Wayzata Blvd, Minnetonka, Minnesota |
| Authorized Official Name and Position | Leland Karl Martin (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9525950562 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Terrace Group Ltd 10580 Wayzata Blvd Ste 150 Minnetonka MN 55305-1657 Ph: (952) 595-0562 | The Terrace Group Ltd 10580 Wayzata Blvd Ste 150 Minnetonka MN 55305-1657 Ph: (952) 595-0562 |
| NPI Number | 1114974201 |
|---|---|
| Provider Enumeration Date | 05/27/2006 |
| Last Update Date | 03/27/2008 |
| Medicare PECOS PAC ID | 3577580794 |
|---|---|
| Medicare Enrollment ID | O20051027000522 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114974201 | NPI | - | NPPES |
| 5H812MA | Other | MN | BCBS |
| C04096 | Other | MN | MEDICARE |
| 50358 | Other | MN | HEALTH PARTNERS |
| 25G82TE | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP3094 (Minnesota) | Primary |
| Provider Name | Leland K Martin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003855743 PECOS PAC ID: 0042237273 Enrollment ID: I20051027000617 |
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