NPIMap

Organization Active NPI

Acacia Psychological Corporation

Doing business as Acacia Counseling & Wellness

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1043757925
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
GL0058 Issued in MN
Legal business name
ACACIA PSYCHOLOGICAL CORPORATION
Doing business as
Acacia Counseling & Wellness
Practice address
2720 University Ave SE
Unit B
Minneapolis, MN 55414-3210
Phone
(805) 399-2511
NPI assigned
Jan 30, 2017
Last updated
Mar 14, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Authorized official

Name
Brett Donnelly
Title
Co-Owner/Ceo
Phone
(805) 399-2511

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC01316 MN
Clinical Psychologist 103TC0700X GL0058 MN Primary

Addresses

Primary practice location

2720 University Ave SE
Unit B
Minneapolis, MN 55414-3210

Mailing address

948 Embarcadero del Norte
Goleta, CA 93117-5106

Other names 1

  • Acacia Counseling & Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Acacia Psychological Corporation9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2720 University Ave SE
Unit B
Minneapolis, MN 55414
Phone (805) 399-2511

NPI Registry JSON

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1043757925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 EMBARCADERO DEL NORTE",
            "city": "GOLETA",
            "state": "CA",
            "postal_code": "931175106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 UNIVERSITY AVE SE",
            "address_2": "UNIT B",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143210",
            "telephone_number": "805-399-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACACIA PSYCHOLOGICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CO-OWNER/CEO",
        "authorized_official_telephone_number": "805-399-2511"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01316",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "GL0058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acacia Counseling & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 14, 2017; 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.