NPIMap

Organization Active NPI

Plymouth Psych Group, LLC

  • Mental Health Counselor
  • Plymouth, MN
National Provider Identifier
1003195942
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PLYMOUTH PSYCH GROUP, LLC
Practice address
3021 Harbor LN N
Suite 206
Plymouth, MN 55447-5109
Phone
(651) 271-9005
Fax
(763) 271-2707
NPI assigned
Aug 10, 2011
Last updated
Aug 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Israel Sokeye, MDNPI 1548428808
Title
Owner
Phone
(651) 271-9005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

3021 Harbor LN N
Suite 206
Plymouth, MN 55447-5109

Mailing address

3021 Harbor LN N
Suite 206
Plymouth, MN 55447-5109
Phone (651) 271-9005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150915000728 MN Part B Supplier - Clinic/Group Practice 6800103490 Receives reassigned benefits from 25 practitioners
Practice locations: Plymouth, MN

National Provider Directory

National Provider Directory

Locations

3021 Harbor Ln N
Ste 206
Plymouth, MN 55447
Phone (763) 559-1640

9655 Schmidt Lake Rd
Ste 150
Plymouth, MN 55442
Phone (763) 559-1640

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1003195942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 HARBOR LN N",
            "address_2": "SUITE 206",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475109",
            "telephone_number": "651-271-9005",
            "fax_number": "763-271-2707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 HARBOR LN N",
            "address_2": "SUITE 206",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475109",
            "telephone_number": "651-271-9005",
            "fax_number": "763-271-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH PSYCH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "SOKEYE",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-271-9005",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.