Provider Demographics
NPI:1174532279
Name:DESTEIAN, JOHN ARMEN (JD, DPSY)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARMEN
Last Name:DESTEIAN
Suffix:
Gender:M
Credentials:JD, DPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3214
Mailing Address - Country:US
Mailing Address - Phone:651-293-1684
Mailing Address - Fax:651-293-1562
Practice Address - Street 1:950 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3214
Practice Address - Country:US
Practice Address - Phone:651-293-1684
Practice Address - Fax:651-293-1562
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0485103TF0000X, 103TP0814X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24123DEOtherBLUECROSS&BLUE SHIELD