Organization Active NPI

Neurocalm, LLC

  • Counseling Psychologist
  • Minneapolis, MN
National Provider Identifier
1033749163
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
NEUROCALM, LLC
Practice address
2011 Kenwood Pkwy
Minneapolis, MN 55405-2304
Phone
(612) 227-1990
Fax
(612) 314-7041
NPI assigned
Jan 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Dr. Jennifer A Waltman, PSYD; MBANPI 1013524545
Title
Ceo
Phone
(612) 284-3990

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
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X Primary

Addresses

Primary practice location

2011 Kenwood Pkwy
Minneapolis, MN 55405-2304

Mailing address

2011 Kenwood Pkwy
Minneapolis, MN 55405-2304
Phone (612) 227-1990

National Provider Directory

National Provider Directory

Locations

3153 Hennepin Ave
Ste 211
Minneapolis, MN 55408

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1033749163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 KENWOOD PKWY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052304",
            "telephone_number": "612-227-1990",
            "fax_number": "612-314-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 KENWOOD PKWY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052304",
            "telephone_number": "612-227-1990",
            "fax_number": "612-314-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROCALM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-16",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "WALTMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-284-3990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD; MBA"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.