Provider Demographics
NPI:1174694533
Name:PASTOR, DONALD LAURENCE (PHD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LAURENCE
Last Name:PASTOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:430 OAK GROVE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3253
Mailing Address - Country:US
Mailing Address - Phone:612-871-8684
Mailing Address - Fax:612-871-2374
Practice Address - Street 1:430 OAK GROVE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3253
Practice Address - Country:US
Practice Address - Phone:612-871-8684
Practice Address - Fax:612-871-2374
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP1111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical