Basic Information
| Provider Information | |||||||||
| NPI: | 1346594090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUBBS | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D,, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 BANDANA BLVD E | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551085109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076639000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1400 JEFFERSON RD | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550573081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076639000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 5539 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 5539 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.