The Beacon Clinic, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5282 Issued in MN

Legal business name

THE BEACON CLINIC, PLLC

Practice address

790 Cleveland Ave S
Suite 201
Saint Paul, MN 55116-3858

Phone

(651) 805-1752

NPI assigned

Feb 10, 2013

Last updated

Aug 7, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Heather P Libbey, PHDNPI 1932414299

Title

Licensed Psychologist/Director

Phone

(651) 805-1752

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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.

• Heather Patricia Libbey, PHD, LP

  • Clinical Psychologist
  • Saint Paul, MN
  • NPI 1932414299
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1360454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1023357175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 CLEVELAND AVE S",
            "address_2": "SUITE 201",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551163858",
            "telephone_number": "651-805-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CLEVELAND AVE S",
            "address_2": "SUITE 201",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551163858",
            "telephone_number": "651-805-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BEACON CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-10",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "LIBBEY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/DIRECTOR",
        "authorized_official_telephone_number": "651-805-1752",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "5282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; 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.